31. Ocular Trauma Flashcards
look at cranial neuropathy videos, pupil testing, and lateral canthotomy, test will have pictures, will be things that will cause people to go blind, pay attention
generally stay away from MRI because can pull out debris and cause severe injury
trauma
**, anterior chamber, flat due to loss of aqeous humor, iris & ciliary body, plug, iritis, hyphema, lens **
basic anatomy
🏥place & time of injury, circumstances of occurence, ocular history, drug allergies, tetanus immunization, if patient is unable to respond
history
hammering on metal, intraocular foreign body, grinding may suggest corneal foreign body, ***
suggestive history
check visual acuity, external exam palpating the oribts and everiting the lids, pupil exam, motility exam, anterior gement including flourescein staining, anesthesia, opthalmoscopy, radiologic studies, CT preferred over MRI, can do ultrasound but need to know what is going on in the eye first
examination
true ocular emergency, alkali more serious than acid, alkalis include anhydrous ammonia, cement, lye, and drain cleaner, acids include car batterys and chemical reagents, irritants include mace and solvents, initial treatment with topical anesthetics, check for foreign bodies, institute copious irriggation with 2 liters/20 mins of saline or lactated ringers, anything, instill topical anesthetic proparacaine tetracaine, evert lids to remove all solid particulates, irrigate the eye, if litmus paper 5-10 minnutes then test, continue until pH <7, no litmus paper for 20 minutes, IV tubing, IV tubing attached to nasal cannula, IV tubbing attached to Morgan lens, after irrigication use topical cycloplegic agents, topical antibiotics, or pressure patches ***,
chemical burns
central retinal artery occlusion
if suspected, refer to opthalmologist immediately, after initial medical therapy, refer patient to opthalmologist
acute glaucoma treatment
foreign body sensation, pain, tearing, photophobia, oral medicines do not work, foreign bodies are lodged under the upper eyelid, corneal burns from cigarettes can happen suggests abuse and will need to reported, treated with topical antibiotic solution polymyxin/trimethoprim, tobramycin, ciprofloxacin, topical NSAID solution ketorlac, nevenac, porlensa, bromsite, bandage contact lesons, oral analgesic, follow up in 24 hours, refer to opthalmologist if not healed in 25 hours, abraision related to contact lens wear, white corneal infiltrate present or develops, topical anesthetics are contraindicated, do not patch contact lens wearers, dendritic ***, rust ring can be present after removal of corneal foreign body (slip-lamp view)
corneal abrasion
lac ***
up to 40% of eyes with open-globe injury contains at least one intraocular foreign body ***
intraocular foreign bodies
optic nerve ***
assume globe is ruptured, shield and refer to opthalmologist reebleeding into the anterior chamber, glaucoma, 25% of patients have other ocular injuries
hyphema
needs to be fixed right away, or send to opthalmologist, bullous subconjunctival hemorrhage, porptosis, corneal exposure, elevated itrocular pressure leading to blindness, treatment with emergency lateral canthotomy
retrobulbar hemorrhage/orbital compartment syndrome
avoid lid margin retraction, remove superficial foreign bodies, ***
superifical lid lacterations
welder’s burn, snow blindness, symptoms occur a few hours after exposure but is self limited for 14 hours , photophobia, foreign body sensation, tearing, pain, treatment with cycloplegics and topical analgesics
ultraviolet keratitis
damage to head
traumatic optiic neuropathy
periorbital edema, ecchymosis, diplopia, and subcutaneous emphysema and hypesthesia, diplopia secondary to edema, entrapment of extraocular muscles or tissue, surgical indications are persistent diplopia or poor cosmesis, different management dependeing on ENT/vs opthalmology, opthalmology recommends not treating for at least a week
orbital facture
look ominous but are fine, not a problem
conjunctival hemorrhage
know your limits, teardrop pupil and flat anterior chamber suggest penetrating injury, avoid digital palpation, irrigate chemical burns, never MRI if suspected metallic foreign body, never prescribe a topical anesthetic
important points
know your limits, teardrop pupil and flat anterior chamber suggest penetrating injury, avoid digital palpation, irrigate chemical burns, never MRI if suspected metallic foreign body, never prescribe a topical anesthetic
important points
true emergencies like chemical burns or central retinal artery detachment, urgent involves acute angle closure glaucoma, conjunctival/corneal foreign bodies or abrasions, penetrating injuries/ruptured globe, hyphema, retrobulbar hemorrhage/orbital compartment, lid lacerations, radiant energy burns for welders, UV, snow blindness, traumatic optic neuropathy, semi urgents are orbital fractures or subconjunctival hemorrhage
management or referral of orbital trauma
true ocular emergency, alkali burn is more serious than acid, alkali burns are due to anhydrous ammonia, cement, lye, drain clearer, acid is from car batteries, chemical reagents, irritants are from mace or solvents, immediate irrigation is essential, initial treatment is to instill topical anesthetic, check for foreign bodies, institute copious irrigation 2liters/20 mins of saline or lactated ringers, or irrigate with anything
chemical burns
instill topical anesthetic proparacaine/tetracaine, evert lids to remove all solid particles, irrigate the eye, if litmus paper 5-10 minutes then test, continue until pH <7, no litmus paper for 20 minute, IV tubing or IV tubing attached to nasal cannula, IV tubing attached to Morgan lens, following irrigation give topical cycloplegia agent, topical antibiotic, pressure patch, refer promptly to an ophthalmologist
ocular irrigation
if acute glaucoma is suspected, refer to ophthalmology immediately, after initial medical therapy, refer patient to ophthalmology
acute glaucoma treatment
foreign body sensation, pain, tearing, photophobia
corneal abrasion symptoms
second opthalmologic emergency
central retinal artery occlusion
start therapy or refer to opthalmologist
acute glaucoma treatment
foreign body sensation, pain, tearing, photophobia, can be detected with strip, foreign body is sometimes underneath the eyelid, can also be present from cigarettes
corneal abrasion symptoms
stop examination, shield eye - do not patch it, give tetanus prohylaxis, refer immediatley to opthalmologist, small brown piece is part of the ciliary body, oblong iris needs to be shielded
if globe ruptured or laceration is suspected
up to 40% of eyes contain with an open globe injury contain at least one intraocular foreign body, paintballs and bb guns, can be detected with watersview CT, if the eye is dilated foreign body can be visible
intraocular foreign bodies
blood in the anterior chamber, shield and refer to opthalmologst, 25% have other ocular injuries, complications include rebleeding into the anterior chamber, glaucoma, 25% of patients have other ocular injuries
hyphema
urgent, needs to be fixed right away, bullous subconjunctival hemorrhage, proptosis, corneal exposure, elevated intraocular pressure leads to blindness,
retrobulbar hemorrhage/orbital compartment syndrome
welder’s burn, snow blindness, symptoms occur a few hours after exposure but self limited for 24 hours, photophobia, foreign body sensation
ultraviolet keratitis
damage to head, orbit, or globe, direct laceration of the optic nerve and intraorbital hemorrhage, shear forces on nerve or vascular supply, visual loss is severe and imemdiate, relative afferent pupillary defect, treatment with orbitalcraniosurgery
traumatic optic neuropathy
periorbital edema, ecchymosis, diplopia, and subcutaneous ephysema and hypesthesia, diplopia secondary to edema, entrapment of extraocular muscles or tissue, surgical indications are persistent diploplia or poor cosemesis, major delay 10-14 days for edema/diplopia to resolve
orbital fracture
know your limits, teardrop pupil & flat anterior chamber is penetrating injury, avoid digital palpation, irrigate chemical burns, never do an MRI, never prescribe topical anesthetics
trauma important points
