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