DIS - Eye Trauma I: Causes and Mechanical Injuries - Week 7 Flashcards
What are the three main sources of eye injury?
Mechanical
Chemical
Radiation/thermal
What are most eye injuries due to (2)?
Flying particles or blows to the head (mechanical injury)
Where do most eye injuries occur?
Workplaces
What are the most common eye injuries (what type)?
Corneal foreign body
What percentage of work-related eye injuries occurs in men?
90%
Which gender is more at risk for eye injuries and by how much (including one for severe eye injury)?
2x males
9x risk of severe eye injury requiring hospital admission
Between urban and rural, which is at a higher risk of eye injuries?
Rural
List the four kinds of contusion injuries.
Abrasions
Lacerations
Foreign bodies
Contusion injuries
List some common causes of conjunctival and corneal abrasions (11).
Fingernail scratch Foreign body Makeup brush Papercut Curling iron Overexposure to UV light Arc-welding CL overwear, illfitting, torn Trichiasis Explosive truma Chemical burn
List three symptoms of a conjunctival abrasion.
Minor irritation
Discharge
-watery
History
What do you expect to see with a conjunctival abrasion on slit lamp (4) and what should you always do (2)?
Abrasion with well defined borders Underlying tissue intact with NaFl staining Surrounding hyperaemia and/or chemosis Always evert both eyes Look at the other eye
Define corneal lacteration.
Cut of the cornea either partial or full thickness
Should corneal lacerations always be referred?
Yes
How are corneal lacerations generally managed (4)? What is a big risk with lacerations?
Sutures are used to close the laceration -iris tissue put back into place -lens may be removed -stitches need to stay for some time Infection is a risk
List 6 symptoms or corneal abrasions.
Gritty sensation through to severe pain Lacrimation Photophobia Blepharospasm Reduced vision Redness
What layer are corneal abrasions generally?
Superficial
-epithelial or stromal
What do you expect to see on slit lamp of corneal abrasions (2)?
Opacity and oedema
Stain with NaFl
What are four differential diagnoses for corneal abrasions?
Infective or inflammatory corneal ulcers
Chemical/flash burn
Recurrent corneal erosion
How should corneal abrasions be managed (2)? Note the drug, duration, and dosage. What about in those wearing contact lenses?
Debride edges -reduces RCE Chlorsig qid In CL wearers, chlorsig with gram negative antibiotic -ciprofloxacin 14 days and 3 days after healed
Should corneal abrasions be patched? Explain why (2).
No
Epithelial healing is slowed and greater pain
Aside from antibiotics, list four treatment options for corneal abrasions.
Oral analgaesic Lubricants (q1h/q2h) Mydriatic if severe discomfort (atropine in office) Bandage soft CL if loose tissue -load first
What is the review schedule for corneal abrasions (2)?
Review 24-48h then every 2-3 days
How long should antibiotics be maintained for corneal abrasion treatment?
Until 3 days after epithelial healing
What is the prognosis of corneal abrasions?
Good, but dependent on depth/location
What is a major cause of recurrent corneal erosions?
Previous corneal abrasion
What do patients with recurrent corneal abrasions typically complain of?
Pain on awakening
What is the cause of recurrent corneal erosions?
Faulty basement membrane
What is the management for recurrent corneal erosions (6)?
Debride the edges if not clean Lubricants, especially at night Ointment at night for many months Hyperosmotics Bandage contact lenses replaced fortnightly/monthly with antibiotics
What can be done for pain with recurrent corneal erosions (2)?
Icepacks
Analgaesia
What are foreign bodies often classified into (4)?
Metallic or non-metallic
Superficial or penetrating
What is the most common type of eye injury?
Foreign bodies
Are the majority of foreign bodies easily removed or is it difficult?
Easily removed
List 7 symptoms of foreign bodies.
No discomfort to severe pain (location dependent) Blepharospasm Epiphora Redness Photophobia Reduced VA History of trauma
When assessing a foreign body, what is it important to distinguish?
Penetrating or perforating
What should you always do when assessing a foreign body?
Lid eversion
What would you expect of patients with subtarsal foreign bodies (2)?
Pain on blinking (subjective)
Vertical corneal abrasion
What are conjunctival or scleral foreign bodies often surrounded by?
Haemorrhages
What do you expect to see with corneal foreign bodies (2)?
Marked vascular injection near FB site
Surrounded by a grey ring of infiltration and oedema
Describe the removal of a superficial foreign body (3).
Use anaesthetic and irrigation
25 gauge bent needle
-spud, spatula, forceps, loop, burr, cotton bud
What is the treatment for foreign bodies after removal (6)? What about contact lens wearers? Note the review.
As with abrasions Broad spectrum antibiotic (4-6 drops loading dose, qid after) Cycloplegics Analgaesics NSAIDs Lubricants Review next day CL wearers as above with ciprofloxacin
What are the symptoms of intraocular foreign bodies ()?
As with superficial, but greater pain
Impacted visions
Oedema
What should you be careful of when assessing an intraocular foreign body?
Not to cause further damage
What is currently the most common cause of intraocular foreign bodies?
Violent behaviour
-glass bottles
What are four signs of penetrating eye injury?
Seidel’s sign
Shallow AC
Decreasing IOP
AC inflammation
What are 4 things that could be done to assess intraocular foreign bodies?
Slit lamp
Gonioscopy
DFE
CT scan
Do intraocular foreign bodies require referrals?
Yes
What is the prognosis for intraocular foreign bodies?
Poor
List 7 sequelae to penetrating eye injury.
Cataract Iris prolapse Hyphaemia Vitreous prolapse Retinal detachment Eyes enucleated Endophthalmitis
Should optometrists attempt to remove penetrating or perforating foreign bodies?
No, refer
Should penetrating or perforating foreign bodies be padded?
No, refer
