Post on 22-Jul-2016
description
Ocular TraumaOcular Trauma
Orbital ArchitectureOrbital Architecture
Nature of InjuryNature of Injury
BluntLaceratingChemical
Blunt TraumaBlunt Trauma
Mild – moderate– “bruise” ocular tissues– Eye wall intact
Moderate – severe– Rupture eye wall– Very severe consequences
Location of InjuryLocation of Injury
AdnexaAnterior SegmentPosterior SegmentOrbital Structures
AdnexaAdnexa
EyelidsLacrimal Structures
Racoon EyeRacoon Eye
Lid LacerationLid Laceration
Anterior SegmentAnterior Segment
ConjunctivaCorneaIrisLens
Posterior SegmentPosterior Segment
VitreousRetinaOptic nerve
Orbital StructuresOrbital Structures
Extraocular musclesBony walls
Common Minor Eye InjuriesCommon Minor Eye Injuries
Corneal abrasionCorneal foreign bodyTraumatic iritis
Corneal AbrasionsCorneal Abrasions
Corneal AbrasionsCorneal Abrasions
Corneal Abrasions - ManagementCorneal Abrasions - Management
• To patch or not to patch, that is the question.• Flynn et al: J. Family Practice. 1998.• Le Sage N et al:Ann of EM. 2001.
• Contact lens wearer • Non-contact lens wearer• Topical anesthetics• Ophthalmology consult?• Follow- up: 48 hrs
Corneal Foreign BodyCorneal Foreign Body
Subconjunctival HemorrhagesSubconjunctival Hemorrhages
• Definition• Symptoms• Signs• Complete exam• Treatment
Subconjunctival HemorrhageSubconjunctival Hemorrhage
Iritis- PresentationIritis- Presentation
• Definition • Symptoms
• Photophobia• Eye pain
• Signs• Limbus injection• Miosis• Mydriasis• VA
Anterior Chamber ReactionAnterior Chamber Reaction
HypopyonHypopyon
Iritis – ManagementIritis – Management
• Complete Examination.• Cycloplegic• Sunglasses• No antibiotics• Topical steroids?• Follow-Up
Hyphema- PresentationHyphema- Presentation
• Definition• Symptoms• Grading
• 0 RBC’s• I <1/3• II 1/3 – 1/2 • III > 1/2• IV eight ball
Hyphema- ManagementHyphema- Management• Ophthalmic consult• Pupillary play/Eye Patch• IOP control > 30 mmHg (>24 mmHg in HbSS)• Admission
• Complications• Re-bleed• Post-traumatic glaucoma
Lens subluxation Lens subluxation and dislocationand dislocation
• Definition• Disposition
• Subluxed• Dislocated
• Post-traumatic Cataract
Retinal Detachment /Vitreous HemorrhageRetinal Detachment /Vitreous Hemorrhage
• Definition
• Symptoms• Photopsia• Image distortion• Painless• Floaters• Floaters with flashing light• Defects in VA
Vitreous HemorrhageVitreous Hemorrhage
• VA/Red reflex/RAPD• Fundoscopy• Ophthalmology consult• Disposition
Retinal DetachmentRetinal Detachment
• RAPD/VA• Fundoscopy• Ophthalmology consult• Disposition
Retrobulbar Hemorrhage - PresentationRetrobulbar Hemorrhage - Presentation
• Definition• Symptoms• Critical signs
• Proptosis• Visual acuity• Marcus-Gunn pupil• Red desaturation
Retrobulbar Hemorrhage-Retrobulbar Hemorrhage-ManagementManagement
• Progressive• Lateral canthotomy
• CT scan of orbit• Disposition
Lacerating TraumaLacerating Trauma
“cut” eye wallOutcome depends on extent and location
Ruptured Globe –Ruptured Globe –PresentationPresentation
• Incidence• 1.1-3.5%
• Symptoms• Predictive signs
1) VA showing light perception or worse. 2) Abnormal deep/shallow anterior chamber.3) Opacity preventing view of fundus.4) IOP of 5 or less.
Ruptured Globe - ManagementRuptured Globe - Management
• Diagnosis Suspected – STOP Examination• Do NOT put pressure on globe• Antibiotics• Tetanus• CT scan• Prepare for surgery.
Corneal LacerationCorneal Laceration