Sam Alexander, MD

Ocular Trauma &

Emergencies

1.3 million eye injuries per year in the United States

40,000 of these injuries lead to visual loss

Eye Trauma: Incidence

Are one or both eyes affected?Vision at time of examination?Vision prior to trauma?

The History: Vision

Symptoms besides decreased vision?Duration of symptoms?Any surgery prior to trauma?

The History: Symptoms

Are one or both eyes affected?Vision at time of examination?Vision prior to trauma?

The History: Vision

Complete Eye ExaminationVision

External exam

Pupils

Motility exam

Anterior segment

Ophthalmoscopy

Pressure

Visual fields

A true ocular emergencyAlkali more serious than acidImmediate irrigation essential

Chemical Burns

Irrigation of chemical burns should be initiated before arrival

at emergency center.

Topical anesthesiaCopious irrigationCheck for foreign bodies

Chemical Burns: Initial EC Management

Topical cycloplegicTopical antibioticPatch eyePrompt referral to ophthalmologist

Chemical Burns: EC Treatment Following Irrigation

Assume globe is rupturedShield eye and refer to ophthalmologist25% of patients have other ocular injuries

Management of Hyphema

Surgery indicated only for persistent diplopia or poor cosmesis

Surgery can be delayed since diplopia may be transient

Orbital Trauma: Isolated Blow-Out Fractures

Avoid lid margin retractionGive tetanus prophylaxisRemove superficial foreign bodiesRule out deeper foreign bodies

Superficial Lid Lacerations

Foreign body sensationPainTearingPhotophobia

Corneal Abrasions: Symptoms

Topical cycloplegicTopical antibiotic

Corneal Abrasions: Treatment

Thank You!

Questions?