Eye Injuries

Question 1

The eye is composed of
three layers:

Answer 1

1) The external fibrous layer or outer wall (cornea and sclera)

2) The middle vascular layer (choroid, ciliary body, and iris)

3) The internal layer (retina)

Question 2

What are the most common eye injuries?

Answer 2

1) Eyelid lacerations
2) Corneal abrasions and corneal foreign bodies
3) Conjunctival injuries
4) Orbital fractures

Question 3

What are the symptoms of corneal abrasions?

Answer 3

1) Severe eye pain
2) Reluctance to open the eye
due to photophobia
3) Foreign body sensation
4) Normal visual acuity
5) Normal pupillary response
6) Staining defect on fluorescein examination

Question 4

What are the symptoms of ocular chemical burns?

Answer 4

1) Decreased vision
2) Moderate to severe eye pain,
3) Blepharospasm (inability to open the eyelids)
4) Symblepharon (lid attached to globe)
5) Conjunctival redness
6) Photophobia

Question 5

Management for ocular chemical burns?

Answer 5

1) Continuous irrigation with water or saline until neutral pH in the eye is achieved (usually takes 30 to 60 minutes)

2) Morgan lens can be used

3) Irrigation should be less forceful if a concomitant globe rupture is suspected

Question 6

Signs & Symptoms of orbital compartment syndrome?

Answer 6

1) Acute onset of decreased vision
2) Diplopia
3) Eye pain
4) Periorbital swelling/ hemorrhage
5) Subconjunctival hemorrhage
6) Chemosis
7) Proptosis
8) Ophthalmoplegia
9) Afferent pupillary defect
10) Tightness of the eyelids
11) Decreased retropulsion (resistance to attempts to push the eye farther back into the orbit).

Question 7

Management of orbital compartment syndrome?

Answer 7

1) Immediate decompression
2) Lateral canthotomy and inferior cantholysis
3) Evaluation for and management of coagulopathy and orbital imaging (CT or MRI)

■ MRI is contraindicated if a metallic intra-orbital or intraocular foreign
body is suspected.

Question 8

Signs & symptoms of open globe injury?

Answer 8

1) Markedly decreased visual acuity
2) Relative afferent pupillary defect
3) Eccentric or teardrop pupil
4) Extrusion of vitreous
5) External prolapse of the uvea (iris, ciliary body, or choroid) or other internal ocular structures
6) Tenting of the cornea or sclera at the site of globe puncture
7) Low intraocular pressure
8) Seidel sign

Question 9

Signs & symptoms specific for blunt injury to the eye?

Answer 9

1) Subconjunctival hemorrhage superiorly

2) Conjunctival laceration

3) Hyphema (blood in the anterior chamber)

4) Iridodialysis superiorly

Question 10

Signs & symptoms specific for penetrating injury to the eye?

Answer 10

1) Full thickness corneal laceration from a fragment of glass
2) Uveal tissue and aqueous are seen prolapsing through the wound

Question 11

Management of open globe injuries?

Answer 11

1) Urgent ophthalmologic evaluation
2) NPO state
3) Prophylactic antibiotics to avoid posttraumatic endophthalmitis
4) Tetanus prophylaxis for ocular lacerations
5) Rapid primary closure of an open globe injury, ideally within 24 hrs
6) Rapid closure promotes the best visual outcome

Question 12

Indications for surgical clot evacuation in hyphema:

Answer 12

1) Large persistent hyphemas (≥grade III for >10 days)

2) Early corneal blood staining

3) Uncontrolled intraocular pressure (ie, ≥50 mmHg for >5 days) despite maximal medical therapy

Question 13

What does a vitreous hemorrhage indicate?

Answer 13

Retinal tear or detachment

Question 14

Vitreous hemorrhages are associated with __ in infants.

Answer 14

Abusive head trauma

Question 15

Retinal detachment may cause:

Answer 15

1) Light flashes
2) Floaters
3) Visual disruption

Question 16

Detachments that threaten the __ and ___ warrant urgent repair.

Answer 16

Macula; Central vision

Question 17

What is commotio retinae?

Answer 17

Retinal edema after blunt closed globe injury

Question 18

What does ophthalmoscopy show in commotio retinae?

Answer 18

Retinal whitening with normal vessels

Question 19

Signs & symptoms of optic nerve injury (traumatic optic neuropathy)?

Answer 19

1) Decreased vision
2) Desaturation of red color or decreased color vision in the affected eye
3) Afferent pupillary defect

Question 20

What are the mechanisms of optic nerve injury?

Answer 20

1) Direct nerve injury (uncommon)

2) Indirect nerve injury: more common, results from contusion of the nerve within the optic canal.

Question 21

What is the cause of a direct optic nerve injury?

Answer 21

Lacerating injury

Question 22

What is the cause of an indirect optic nerve injury?

Answer 22

A forceful blow to the temple or the brow

Question 23

Head trauma can cause a __.

Answer 23

Carotid cavernous sinus fistula

Question 24

Signs & symptoms of a carotid cavernous sinus fistula?

Answer 24

1) Ocular surface vessels appear tortuous (“corkscrew”) and dilated with concomitant chemosis (edema of the
conjunctiva)

2) Retinal vessel distension and high intraocular pressure

3) Mild proptosis and engorgement of the episcleral vessels

4) Dilation of the retinal vasculature

Question 25

Signs & symptoms of acute angle-closure glaucoma?

Answer 25

1) Dilated conjunctival
vessels especially near the
cornea (ciliary flush)

2) Slightly hazy cornea (edematous).

Question 26

What is Iridodialysis?

Answer 26

Separation of the iris from its insertion at the ciliary body