Caring for patients with eye injuries, neoplastic growth of the eye.
Lecturer: Lilya Ostrovska
Ocular Trauma
Nature of InjuryBluntLaceratingChemical
Blunt TraumaMild moderatebruise ocular tissuesEye wall intactModerate severeRupture eye wallVery severe consequences
Lacerating Traumacut eye wallOutcome depends on extent and location
Location of InjuryAnterior SegmentPosterior SegmentAdnexaOrbital Structures
Anterior SegmentConjunctivaCorneaIrisLens
Posterior SegmentVitreousRetinaOptic nerve
AdnexaEyelidsLacrimal Structures
Orbital StructuresExtraocular musclesBony walls
Disgusting PhotographsFront to back
Racoon Eye
Lid Laceration
Subconjunctival Hemorrhage
Corneal Foreign Body
Corneal Abrasion
Curling Iron Burn
Corneal Laceration
Iris Sphincter Rupture
Hyphema
Traumatic Cataract
Vitreous Hemorrhage
Retinal Hemorrhage
Optic Disc Hemorrhage
Orbital Wall Fracture
Common Minor Eye InjuriesCorneal abrasionCorneal foreign bodyChemical splashTraumatic iritis
DiagnosisHistorySharp vs blunt vs chemical injuryExamCHECK VISIONCHECK VISIONCHECK VISION
Diagnosis cont.Exam Pry lids apart!Cornea clear?Pupil round?Pupil black?Blood clotted behind cornea?
Diagnosis cont.ExamRed reflex?Eyes move symmetrically?
Fluorescein TestTopical eye dyeCOBALT light
Corneal Abrasion
Abrasion TreatmentErythromycin ointment+/- patch1-2 day follow-up with eye doc
Corneal Foreign Body
Foreign Body TreatmentAnesthetize eyeRemove FBCotton swab (dont worsen abrasion!)Kimura spatula+/- needle tipE-mycin and +/- patch1-2 day follow-up with eye doc
Chemical Splash
Chemical TreatmentIRRIGATECheck pHMinorE-mycin ointment1 day follow-up eye docMajorSame day eval by eye doc
Traumatic IritisModerate blunt injuryPhotophobiaLid bruising/edemaSubconj heme or injectionPupil sluggishEval by eye doc
Please Do Not ConfuseSubconjunctival hemorrhageHyphema
OCULAR ONCOLOGY
OSSNOcular surface squamous neoplasiaEncompasses conjunctival/corneal intraepithelial neoplasia (CIN)
Squamous conjunctival dysplasiaCarcinoma in situInvasive squamous cell carcinoma (SCC)
Squamous cell carcinomaExtensiveIll defined edgesVascularisedCorneal involvement
Conjunctival melanomaPrimary aquired conjunctival melanosis (PAM)Preexisting conjunctival naevusDe novo
PAMBiopsy if:GrowthNodule formationVascularityPrimary acquired conjunctival melanosis
De novo conjunctival melanoma
Rx Conjunctival SCC / MelanomaExcision / cryotherapy to cut conjunctival marginTopical Mitomycin CEpiscleral plaque radiotherapy if recurrence
Iris melanoma
Congenital hypertrophy of the retinal pigment epithelium (CHRPE)
Choroidal neovascularisation: high myopia (Fuchs spot)
Choroidal haemangioma
Melanocytic tumours of the posterior uveaNaevusMelanoma
DrusenFibrous metaplasia of RPEChoroidal naevus
Uveal melanoma treatmentObservationTumours < 2mm thick
SymptomsThickness > 2mmOrange pigment (lipofuscin)GrowthSubretinal fluidPeripapillary location
Uveal melanoma treatmentObservationTranspupillary laser thermotherapy (TTT)
Uveal melanoma treatmentObservationTTTLocal resection
Anterior to equatorBase < 10mm
Ruthenium 106Iodine 125
Uveal melanoma treatmentObservationTTTLocal resectionRadioactive plaque therapyProton beam/helium ion irradiationGamma knife therapy
Uveal melanoma treatmentObservationTTTLocal resectionRadioactive plaque therapyProton beam/helium ion irradiationGamma knife therapyEnucleationBase > 15mm
Metastatic tumoursBreast / lung carcinoma
AmelanoticMultifocalChoroidal
Treat only if sight affected
AmelanoticMultifocalChoroidalPosterior to equator
THANKS FOR YOUR ATTENTION !
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