DIS - Eye Trauma II: Contusion Injuries - Week 7 Flashcards by B H

Can you see the borders of subconjunctival haemorrhages?

Yes

How well did you know this?

Not at all

Perfectly

How long do subconjunctival haemorrhages take to heal?

14 days

How well did you know this?

Not at all

Perfectly

Define contusion injury. What causes the damage?

Blunt trauma
Damage is caused by pressure wave across the eye

How well did you know this?

Not at all

Perfectly

What happens to IOP with contusion injury?

Transient but large change in IOP

How well did you know this?

Not at all

Perfectly

Describe the coup mechanism for damage caused by contusion injury.

Local trauma at the site of impact

How well did you know this?

Not at all

Perfectly

Describe the contre-coup mechanism for damage caused by contusion injury.

Injury at the opposite side of the eye caused by shockwaves striking the posterior pole

How well did you know this?

Not at all

Perfectly

Describe the ocular compression mechanism for damage caused by contusion injury.

Globe is initially compressed by an object then rebounds, overshoots, and stretches beyond normal shape

How well did you know this?

Not at all

Perfectly

List 10 anterior segment manifestations of contusion injury.

Abrasion/laceration
Lid/conjunctival ecchymosis
Hyphaema
Torn iris/iridodialysis
Angle recession
Lens dislocation
Cataract
Vossius ring
Traumatic uveitis
Corneal endothelium damage

How well did you know this?

Not at all

Perfectly

List 4 posterior segment manifestations of contusion injury.

Commotio retinae
Haemorrhages
Retinal tear/detachment
Macular oedema/holes

How well did you know this?

Not at all

Perfectly

What is the most common form of contusion injury? List 5 symptoms.

Corneal abrasions
-pain
-blepharospasm
-lacrimation
-pseudoptosis
-photophobia

How well did you know this?

Not at all

Perfectly

Why is ecchymosis common in the lids?

Vascularity and loose tissue structure

How well did you know this?

Not at all

Perfectly

Can ecchymosis spread to the other eye?

Yes, due to subcutaneous supply

How well did you know this?

Not at all

Perfectly

What do fractures to the orbit most commonly affect (2)?

The floor and medial wall

How well did you know this?

Not at all

Perfectly

Which region of the orbit is the most likely to fracture? Where does it frequently occur along?

The floor of the orbital rim
Frequently occurs along thin bone covering infraorbital canal

How well did you know this?

Not at all

Perfectly

Where do the bones of the maxilla tend to collapse into and what happens as a result?

Collpase into the maxillary sinus, orbital contents prolapse into the cavity created

How well did you know this?

Not at all

Perfectly

What two muscles are generally affected by fractures of the orbital floor?

Inferior oblique and rectus
-defective elevation

How well did you know this?

Not at all

Perfectly

What sinuses are involved with medial wall fractures? What are medial wall fractures most associated with?

Ethmoid sinuses
Medial wall fractures most associated with floor fractures

How well did you know this?

Not at all

Perfectly

What are medial wall fractures apparent with?

Air crepitus
-air under skin

How well did you know this?

Not at all

Perfectly

What should patients with a medial wall fracture avoid and why?

Avoid blowing nose or air may be forced into the soft tissue of the lids and surrounding skin

How well did you know this?

Not at all

Perfectly

Are subconjunctival haemorrhages common or rare?

Quite common

How well did you know this?

Not at all

Perfectly

How long do subconjunctival haemorrhages require to resolve and what treatment?

Several weeks
-no treatment needed
-can do cold compress first 24h, then warm compress next day

How well did you know this?

Not at all

Perfectly

What is necessary to to confirm subconjunctival haemorrhage? What if you do not see this?

Defineable posterior border
-need imaging if you dont see

How well did you know this?

Not at all

Perfectly

What should you do if you suspect idiopathic subconjunctival haemorrhage?

Blood thinners

How well did you know this?

Not at all

Perfectly

List four characteristics of ruptures to sphincter pupillae.

Irregular, semi-dilated pupil
Pupils dont react to light/accommodation
Increased glare sensitivity
Monocular diplopia

How well did you know this?

Not at all

Perfectly

List four characteristics of iridodialysis.

Often hyphaema Pupil distortion Increased glare sensitivity Monocular diplopia

What should you rule out of the iris with contusion injury?

Hyphaema

If there is iris damage with contusion injury, is it advisable to do gonioscopy?

Not for the first week

List 5 tests to do to assess the iris with contusion injury.

DFE VA IOP Pupils CV

What may be used in traumatic iritis initially if due to corneal abrasion and over what other drug?

Cycloplegic initially rather than steroids

Describe how contusion injury can result in angle recession (3).

Cornea is abruptly forced back, pressing on the iris, and against the lens Aqueous cannot move into the posterior chamber, and moves into ciliary body This tears the anterior face of the ciliary body at insertion

What can occur with angle recession and how long later?

Unilateral glaucoma months or years later

What do you expect of the pupil with angle recession due to contusion injury?

Traumatic mydriasis

Define hyphaema. What causes it?

Blood in the anterior chambel Due to the rupture of iris or ciliary body vessels

What happens with hyphaema in most cases?

Resorbed without serious consequences

If not resorbed in a few days, what can occur with hyphaema (3)?

Increased IOP Blood staining the cornea Secondary glaucoma

How should cases of hyphaema be managed by optometrists?

Refer all cases unless its only trace

Describe the five grades of hyphaema.

Trace - RBCs visible, no layering Grade 1 - <1/3rd AC depth Grade 2 - 1/3 to 1/2 AC depth Grade 3 - 1/2 to 90% AC depth Grade 4 - 100% AC depth

What is the management with hyphamea (5)?

No physical activity Bed rest with 30 degree head elevation 5% homatropine qid Monitor for reebleed Acetaminophen for pain

What two medications hsould individuals with hyphaema not take?

Aspirin NSAIDs

How should cases of hyphaema be reviewed?

Every day for 3-4 days

What should you do if you see inflammation and IOP increase with hyphaema?

Inflammation - pred acetate 1% q2h IOP increase - timolol 0.5% bid

When should you do gonioscopy on patients with hyphaema?

Several weeks after it is cleared

List 6 features of partial or total lens dislocation.

Reduced VA Irregular astigmatism Myopic shift Abnormal ret reflex Monocular diplopia Deeper AC

List a feature of partial lens dislocation.

Tearing of suspensory ligaments

What is a vossius ring and in what age group is it more common?

Circle of iris pigment on the lens from impact of iris against lens More often in the young

List three features of a rosette cataract. What two injuries can cause it? Is its onset acute or delayed?

Vacuoles, oedema, and fibre degeneration Onset may be delayed Contusion or perforation injuries

Are diffuse cataracts common or rare?

Rare

What are diffuse cataracts usually associated with? What may occur as a result (2) and with what?

Torn capsule -secondary glaucoma or anterior uveitis can occur if the tear is large

Are zonular cataracts common or rare?

Rare

How do zonular cataracts appear?

Series of concentric opacities surrounded by clear lens

List 9 posterior segment damages you may see as a result of contusion injury.

Oedema Cysts Holes Necrosis Atrophic retinal changes Commotio retinae Retinal detachment Haemorrhages Choroidal tears

What is commotio retinae?

Retinal oedema

What appearance may the retina have with contusion injury? Is it transient or irreversible? What areas are usually affected and what layers of the retina is it confined to? Does it affect vision? Can it cause permanent damage?

Retina may appear milky within a few hours Transient and reversible (usually four days) Affects area surrounding ONH and macula Confined to outer retinal areas Vision reduced May have permanent impairment due to development of pigmentary changes at the macula, cyst, or hole

What may occur with severe commotio retinae?

Cystoid muller cells may rupture, exacerbating oedema

When do choroidal tears often occur? What consequence does it have?

Occurs when trauma is combined with increase in IOP Allows fluid to enter suprachoroidal space

Where do choroidal tears usually occur (2)?

Between the disc and macula or temporal to the macula

Wha can choroidal tears lead to?

Haemorrhage

Where do retinal detachments tend to occur if shortly after trauma? Otherwise, where?

Typically supero-temporal periphery Otherwise commonly supero-nasal

What is a strong indicator of retinal detachment?

Tobacco dust in the anterior vitreous

What are three diseases that increase the risk of trauma related retinal detachment?

High myopia Peripheral retinal degeneration Aphakia

Are myopic changes more or less common with trauma? Explain why and note if it is permanent or transient.

More common due to spasm of accommodation Usually transient

What five things should you assessif you suspect contusion injury?

Orbital fracture EOM entrapment Globe position Globe rupture (seidel test) Anterior and posterior segments

What are 7 screening tests to do if you suspect contusion injury?

VA Pupils Oculomotility Colour vision NPA Amsler IOP

Should you refer if there is retinal/ON dmaage with contusion injury?

Yes

What test is done to assess bone damage?

CT scan