Eye injury Flashcards
What are the main types of eye trauma?
- Corneal abrasions
- Foreign bodies
- Radiation damage
- Chemical damage
- Blunt injuries with hyphaema
- Penetrating injuries
What are features of a blunt force trauma to the eye?
- Lid injury
- Orbital blow-out fracture
- Corneal abrasion
- Anterior hyphema
- Traumatic mydriasis
- Lens dislocation
- Vitreous hemorrhage
- Retinal detachment
- Traumatic iritis
- Ruptured globe
When taking a history of a blunt eye injury, what would you want to ask about?
- Symptoms — visual disturbance or loss of vision, pain at rest or on movement, and diplopia.
- Mechanism of injury — any suspicion of penetrating eye trauma requires prompt assessment, so that urgent referral can be made.
- Type of projectile and velocity — small high-velocity projectiles are at higher risk of penetrating injury.
- Use of eye protection
- Associated injuries
What investigations would you do for blunt eye trauma?
- Consider CT or XR of the orbits if an orbital wall fracture is suspected.
- CT head/ neck if coexistent head and neck injuries need to be ruled out.
How would you manage blunt trauma to the eye?
Refer to opthalmology
- Bed rest
- Head elevation
- Analgesia
- Topical steroids - G. Predforte
- Topical cycloplegics - Atropine
- Topical IOP lowering - if needed
What signs might suggest a blowout fracture or the orbit in a blunt eye injury?
Decreased sensation of the lower eyelid - infra-orbital nerve injury
What injuries resulting from eye trauma usually require immediate consultation with an ophthalmologist?
- Chemical burns of the eye
- Perforation of the globe or cornea
- Lens dislocation
- Orbital hemorrhage with increased IOP
- Lacerations - lid margin, tarsal plate or nasolacrimal drainage system
- Optic nerve injury
What traumatic eye injuries do not usually require immediate assessment by an ophthalmologist, but should be followed up within ~24 hour?
- Anterior hyphema
- Blow-out fracture
- Retinal injuries
What are features of penetrating eye trauma?
- Corneal or Corneal Laceration
- Severe conjunctival chemosis and haemorrhage
- Ocular hypotony
- Shallow anterior chamber
- Irregular pupils
- Extrusion of intraocular contents
- Limited extraocular movements
What are complications of penetrating eye injury?
- Permanent loss of vision — enucleation may be necessary
- Corneal ulcers — may lead to delayed perforation.
- Infection — e.g. endophthalmitis
- Sympathetic ophthalmia — enucleation of the severely traumatised eye should be performed initially or within 1-2 weeks to prevent this in the severely damaged eye
What is the management of a penetrating eye injury?
STOP EXAMINATION an Immediate opthalmological referral
- Apply eye shield (NO PATCH) on affected eye
- Consider pathcing padding unaffected eye - prevent conjugate movement
- Tetanus prophylaxis
- Systemic antibiotics
- NBM
- X-ray/CT Orbit
What aspects of the history may suggest a penetrating eye trauma?
Working with flying objects - e.g. hammer, lathes, chisels
What type of chemical burns are more dangerous; acid or alkali?
Alkali - tend to penetrate cornea faster and rapidly damage intraocular contents
What effect do acids have on the eyes?
Tend to coagulate corneal proteins - this stops penetration
How would you manage someone with chemical burns to the eyes?
Stabilise
- Immediate copious irrigation with 1-2 litres of Saline
- Topical anaesthetic
- Double eversion of eyelids - thorough cleansing
Once stabilised
- Topical antibiotics
- Lubricants
- Cycloplegics
- Vitamin C
- Steroids
REFER TO OPTHALMOLOGIST
What features can be seen in an injured eye?
Always refer
- Abnormal eye movements
- Basal tear of iris
- Hyphaema
- Marginal laceration
Other
- Foreign body
- Distorted pupil
- Subconjunctival haemorrhage
- Epithelial loss
How would you remove a foreign body from the eye?
- Use local anaesthetic
- If the foreign body is loose, irrigate the eye
- If the foreign body is adherent, use a cotton wool bud or the edge of a piece of cardboard
What are features of an orbital blowout fracture?
- Diplopia
- Recessed eye
- Reduced vertical gaze
- Subconjunctival haemorrhage
- Swollen lid
- Ipsilateral nose bleed
- Loss of sensation
