Ocular injuries- Third year mbbs Ophthalmology
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Transcript of Ocular injuries- Third year mbbs Ophthalmology
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