2 - Trauma

Question 1

Chemical burn

• who
• signs/symp
• alkali vs acidic

Answer 1

66% in industrial settings

Normal or decr vision, pain, FBS, photophobia, tearing, blepharospasm
Range: mild SPK to sloughing of entire epithelium
Conj injection/hemorrhage/chemosis, ciliary injection, AC rxn, scleral + limbal blanching
Severe may incr IOP

Alkali: worse, twice as common, raise pH =breakdown of FA in cell membr = faster penetration

• limbal blanching is an indicator of ischemia
• ammonia, magnesium hydroxide, lime, airbag residue, most common = calcium hydroxide

Acidic
-hydrofluoric/sulfuric/nitric/chromic acid, PAVA spray

Question 2

Corneal abrasion

• who
• signs/symp

Answer 2

Always a hx of trauma

Sharp pain (CASA), FBS, photophobia, tearing, blur
Mild AC rxn, miotic pupil
Stains with fluoro, no underlying SEI

Question 3

Corneal/conj superficial FBs

• what it’s made of
• signs/symp

Answer 3

Metallic
Non-metallic: vegetable matter, cloth particlees, cilia, stone, glass

FBS, tearing, redness, photophobia, decr VA, corneal edema, mild AC rxn
+/- sterile infiltrate
Rust ring with metallic (alger brush)

Question 4

Ruptured globe/penetrating ocular injury

• who
• signs/symp

Answer 4

Young to mid-age males (3:1)

Pain, blur, redness, photophobia, tearing
Severe conj hemorrhage, EOM restriction, POSITIVE SEIDEL (black river due to diluted dye from aqueous), low IOP, HYPHEMA, COMMOTIO RETINAE, choroidal rupture, tractional RD

Question 5

Hyphema

• causes
• signs/symp
• management

Answer 5

#1: Hx of blunt or penetrating trauma to iris and/or CB
Systemic dz, idiopathic = blood-thinners (NSAIDs)

Pain, blurred vision, blood in AC
+/- sphincter tears, iridodialysis (root from CB), ct, lens subluxation, Vossius ring, commotio retinae, angle recession

No gonio or scleral depression until 1 mo
B-scan indicated if occlusion of fundus
Elevate head 30 degrees to allow RBCs to settle inferiorly, avoid blocking TM/IOP spike

Question 6

Anterior chamber concerns

• cells/flare
• hypopyon

Answer 6

Ant uveitis, corneal abrasion

Ulcers, endophthalmitis

Question 7

2 major reasons to perform B-scan

Answer 7

ONH drusen

Choroidal nevus vs melanoma

Question 8

What blood test should you run on a pt who presents with an idiopathic hyphema (3)

Answer 8

CBC
PT/PTT
Sickle-cell screening

Question 9

Intraocular FB

• signs/symp
• inflamm or not

Answer 9

Pain, decr VA, CT (not MRI, esp if suspected metal) and/or B-scan, TID, decr IOP

Significant inflamm: iron (e.g. BBs), steel, copper, vegetable matter
No inflamm: glass, stone, precious metals, plastic (inert materials)

Question 10

Orbital fracture

• signs/symp
• what is affected, trapped

Answer 10

Pain, binoc diplopia, crepitus, enophthalmos, step-off fracture, globe ptosis (actual eye sinks down), infraorbital hypoesthesia

IR/IO = limited upgaze, downgaze, or both
CN V2 (infraorbital) = cheek hypoesthesia

Question 11

Commotio retinae

Answer 11

Vitreous smacks PR outer segs
Usually resolves (-) sequelae: disappears in 48-72h, resolves 3-6w
Typically asymptomatic, acute vision loss if within macula (Berlins)
Gray-white discoloration
Berlin’s edema if in macula

Question 12

Iridodialysis

Answer 12

Separation of iris root from CB
Peripheral hole best seen with retroillumination
Monitor for angle recession glaucoma

Question 13

Vossius ring

Answer 13

Pigment ring on ant lens from contact with PPIE

Question 14

Purtcher’s retinopathy

• cause
• signs/symp

Answer 14

Acute chest-compressing trauma
Acute pancreatitis, renal failure, long bone fractures

Diffuse retinal hemorrhages, exudates, CWS

Question 15

Choroidal rupture

• signs/symp
• concern

Answer 15

Single/multiple area(s) of subretinal hemorrhage - esp TEMPORAL posterior pole with CRESCENT-SHAPED tears CONCENTRIC to optic nerve head

CHBALA (5-10%)

Question 16

Eyelid ecchymosis

Answer 16

Bruise/black eye from leaking BVs in subQ tissue