2.1: Ocular Trauma

Question 1

Of all the acute ocular presentations that present to hospital, what are the presenting complaints?

Answer 1

45% Injuries
45% Red Inflamed Eyes
10% Miscellaneous - Reduced eye vision, visual disturbances, contact lens problems

Question 2

What are the causes of ocular injuries?

Answer 2

Work related - often minor
Assault
Accidents around the home
Sports injuries
Other causes

Question 3

Describe 3 mechanisms of trauma?

Answer 3

Blunt
Penetrating - Large or small objects
Burns - Chemical or physical

Question 4

Describe assessment of eye injury?

Answer 4

Good history
Visual acuity
Examination of the eye - lids, conjunctiva, cornea, anterior segment, pupils, funds
Use fluorescein drops

Question 5

What are the first three golden rules?

Answer 5

1. History is key
2. Visual Acuity is important
3. Don’t forget Fluorescein

Question 6

Describe a blow out fracture?

Answer 6

This is when the floor or the medial wall of the orbit fractures due to trauma. Can result in double vision, sunken orbital globes or loss of facial sensation

Question 7

Describe a subconjunctival haemorrhage?

Answer 7

This is a bleed into the whites of the eyes caused by burst blood vessels

Question 8

Describe globe rupture?

Answer 8

Ophthalmic emergency
The integrity of the outer membranes is disrupted by blunt or penetrating trauma
Can result in vision loss

Question 9

Describe traumatic uveitis?

Answer 9

Inflammation of the uvea caused by trauma - normally blunt but can include other types of trauma. Common in young males (not wearing eye protection)

Question 10

What is hyphaema?

Answer 10

This is blood in the anterior chamber
Caused by trauma
May partially or completely block vision
Can result in permanent vision loss

Question 11

What is retinal detachment?

Answer 11

This is when the retina detaches from the underlying layer of support tissue
Can be localised or broad (localised can progress)
Can progress to complete retinal detachment
May cause vision loss and blindness
Emergency

Question 12

What is penetrating trauma?

Answer 12

This is when something penetrates into the body (Eg: Skull, the globe, abdomen) and causes injury

Question 13

What is sympathetic ophthalmia?

Answer 13

This is when injury occurs to one eye
Causes auto-immune reaction and inflammation in BOTH eyes
May lead to bilateral blindness from a unilateral injury

Question 14

Describe small particles penetrating trauma?

Worrying signs?

Answer 14

Small particles can penetrate to many parts of the eyes
(Eg: Conjunctiva, sub-tarsal, cornea)

Worrying signs following small particle penetration include:

• Localised cataract
• Gross inflammation
• Irregular pupil
• Shallow anterior chamber

Question 15

Describe intra-ocular small particles?

Answer 15

These are caused by fast moving small particles (Eg: Pieces from hammering and chiseling)
These require an X-Ray to determine location

Question 16

What is the golden rule relating to penetrating trauma?

Answer 16

5. Always X-Ray if suspicious of intra-ocular foreign body

Question 17

Describe chemical burns?

Answer 17

Can be caused by acid or alkali
Alkali has deep penetration (can cause ischaemia)
Acid has very little penetration (red surface)

Question 18

Management of chemical burns?

Answer 18

Quick History

Immediate irrigation

Question 19

Complication of chemical burns?

Answer 19

Can lead to end stage scarring and blindness

Question 20

What is the final golden rule relating to chemical burns?

Answer 20

Immediate irrigation of chemical injuries

Question 21

Describe prevention of ocular injuries?

Answer 21

90% preventable

• Training (up to date)
• Education
• Clear eye protection
• Rules in sport and work

Question 22

Name the six golden rules?

Answer 22

1. Always get a good history
2. Always record visual acuity
3. Don’t forget fluorescein
4. Handle suspected globe rupture with care
5. X-Ray orbits if you suspect intra-ocular foreign bodies
6. Immediate irrigation of chemical injuries

Question 23

What is the golden rule relating to ocular rupture?

Answer 23

Handle suspected globe rupture with care