Conjunctiva: Trauma

Question 1

Describe conjunctival foreign body?

Answer 1

• History – px may present w/ something superficial but don’t want to miss something more significant e.g. penetrating injury, intraocular FB or significant injury involving posterior segment & retina
• If simple conjunctival FB:
  o Irritation, tearing
  o Visible foreign body
  o Subtarsal foreign body
   Pain when blinking
   Evert eyelid in suspect cases
   Linear abrasion on cornea – if small FB embedded on upper eyelid on tarsal plate, whenever they blink it scrapes across cornea
• Can lubricate eye but unless remove FB, they’ll have an ongoing problem
  o Usually removed with soaked cotton bud

Question 2

Desccribe conjunctival laceration?

Answer 2

• Hx of trauma
• Mild pain, red eye – make sure no other injury to eye itself – perform complete examination
• Fluorescein staining
• Associated with adjacent subconjunctival haemorrhage – laceration will have ruptured some BVs
• Requires close inspection to exclude scleral injury – especially if large area >5-10mm – beware chemosis  see px back after few days or a week to make sure it resolved, especially if px in significant pain
  o Usually resolves on own – conj heals well
• Usually resolves with lubrication – no other intervention may be needed other than an antibiotic ointment  antibiotic to prevent any secondary infection

Question 3

Describe subconjunctival haemorrhage?

Answer 3

• Asymptomatic or Mild irritation
• Blood underneath conjunctiva
  o Valsalva – straining, lifting heavy object
  o Traumatic
  o Hypertension – rare
  o Bleeding disorder – rare
  o Idiopathic – most commonly

Question 4

Describe chemical injury?

Answer 4

• Chemosis
• Conjunctival blanching – chemical has essentially killed off conj & killed off all BVs – a white eye in context of chemical injury is BAD NEWS
• Associated corneal epithelial defects
• Can be due to a liquid but can also be due to things like cement particles
• Tx:
  o IMMEDIATE IRRIGATION – before even referring – to stop px developing blinding eye disease
   Initially in practice – with saline or sterile water – to try & remove all particles of thing that caused the chemical injury  delaying irrigation & initial management by couple of hours can cause significant sight-threatening eye disease & can leave px with a lot of problems for a long time
• Can be difference between px having clear cornea or one seen in two RHS pics below
  o Search fornixes – to make sure no particles