Ocular Trauma

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Nature of Injury

• Blunt• Lacerating• Chemical

Blunt Trauma

• Mild – moderate– “Bruise” ocular tissues– Eye wall intact

• Moderate – severe– Rupture eye wall– Very severe consequences

Lacerating Trauma

• “Cut” eye wall• Outcome depends on extent and location

Location of Injury• Anterior segment• Posterior segment• Adnexa• Orbital structures

Anterior Segment

• Conjunctiva• Cornea• Iris• Lens

Posterior Segment

• Vitreous• Retina• Optic nerve

Adnexa

• Eyelids• Lacrimal Structures

Orbital Structures

• Extraocular muscles• Bony walls

Disgusting Photographs

• Front to back…

Racoon Eye

• Self limiting if no other injury exists

• No treatment needed• Be sure to open lids

apart to examine the eye structure and motility

Lid Laceration

Lacrimal Duct Laceration

• Repair ASAP• Probing with silicon

tube and suturing

Conjunctival Trauma

• Sub conjunctival hemorrhage– Self limiting – No treatment needed

• Conjunctival laceration– Make sure the sclera is intact– Antibiotic ointment for 1-3 days

Subconjunctival Hemorrhage

External Foreign Body

• Can be in conjunctiva or cornea

• Red painful and watery eye

• Removal under slit lamp

• Patching with antb

Corneal Foreign Body

Corneal Abrasion

• Severe pain and photophobia• Blurry vision• Erosion stains with fluresceine• Patching with antibiotic oint to

prevent infection and help re- epithelization

• Healing 1-4 days

Corneal Abrasion

Chemical Burn

• Usually fat-cleaning materials

• Pain, photophobia• Treatment: irrigation,

irrigation, irrigation

Corneal Penetration

• Minor wound can be self sealing and leave the eye intact

• Patient complains on photophobia and pain

• Only on slit lamp examination perforation is diagnosed

Corneal Perforation -Cont

• Iris can be captured in the perforation wound

• Iris reposition if soon after the injury and corneal suturing

Hyphema• Blood in anterior chamber• Sometimes hard to

diagnose• Blurry vision and pain• Self limiting• Complications: elevation

of intra-ocular pressure and re-bleeding

Traumatic Cataract

• Usually repaired in a secondary operation

• If possible a plastic intra-ocular lens is inserted instead of the damaged lens

• Treatment of amblyopia crucial

Traumatic Cataract

Vitreous Hemorrhage

• Blood in vitreous cavity

• Usually self limiting• Can be cleared with

vitrectomy is rare occasions

Retinal Hemorrhage

Optic Disc Hemorrhage

Intra-ocular Foreign Body

• Ocular emergency• Removal in vitrectomy• Retained FB can cause

infection or retinal degeneration

Orbital Wall Fracture

• Problematic only if:– Limitation of eye

ductions– Disfiguring

enophthalmos

Traumatic Optic Neuropathy

• Optic nerve injured in optic canal

• Usually vision loss• No good treatment• Mega-dose steroids?

Common Minor Eye Injuries

• Corneal abrasion• Corneal foreign body• Chemical splash• Traumatic iritis

Diagnosis

• History– Sharp vs blunt vs chemical injury

• Exam– CHECK VISION– CHECK VISION– CHECK VISION

Diagnosis cont.

• Exam – open lids apart!– Cornea clear?– Pupil round?– Pupil black?– Blood clotted behind cornea?

Diagnosis cont.

• Exam– Red reflex?– Eyes move symmetrically?

Fluorescein Test

• Topical “eye dye”• COBALT light

Corneal Abrasion

Abrasion Treatment

• Antibiotic ointment• +/- patch• 1-2 day follow-up with eye doc

Corneal Foreign Body

Foreign Body Treatment

• Anesthetize eye• Remove FB

– Cotton swab (don’t worsen abrasion!)– Kimura spatula– +/- needle tip

• Antibiotic oint +/- patch• 1-2 day follow-up with eye doc

Chemical Treatment

• IRRIGATE with large amounts of water• Check PH• Minor

– Antibiotic ointment– 1 day follow-up eye doc

• Major– Same day evaluation by eye doc

Traumatic Iritis

• Moderate blunt injury• Photophobia• Lid bruising/edema• Subconjunctival

hemorrhage or injection

• Pupil sluggish• Evaluation by eye doc

Please Do Not Confuse

• Subconjunctival hemorrhage• Hyphema