Eye Trauma Flashcards
How can you categorise eye trauma?
Blunt
lacerating
chemical
How do we classify blunt trauma to the eye?
Mild - moderate
e.g. bruise to the ocular tissues with the eye wall intact
Moderate - severe
e.g. rupture eye wall
very severe consequences
What is a lacerating trauma to the eye
“cut” to the eye wall
outcome depends on extent / location
What causes can you think of for ocular trauma?
Foreign bodies
Corneal abrasions
Disruption of globe
Intraocular foreign bodies
Hyphemas
orbital wall fractures
Chemical injury
What do these show ?
chemical burns ranging from mild inflammation to severe damage
You see this what do you do?
IRRIGATE NOW
alkali burn
How do acid injury’s to eye cause damage?
denaturation and coagulation of protein
acid damaged limited by neutralisation of the buffering nature of tissues
What often causes acid injury to the eye?
Sulfuric / nitric acids
Industrial accidents
Car battery explosions
Compare the damage from acid vs alkali burns
Acid = damage confined to area of contamination
Alkali = damage widespread, uncontrolled and progressive
How do alkali burns cause damage to the eye?
Penetrate ocular tissues rapidly, produce intense ocular reactions
epithelial loss
corneal opacification
scarring
severe dry eyes
cataract
glaucoma
blindness
Treatment for chemical injury to eyes?
IRRIGATION - complete and copious!
within minutes
Describe how you would irrigate the eyes of a pt with chemical injury to the eyes?
Drop of topical anesthetic if available (proparicaine)
eye irrigation solution and normal saline IV drip
Squeeze copious solution into the eye, direct towards temple (AWAY from unaffected eye)
Irrigate under the lids
When should you check pH of eyes with a pt with a chemical injury?
After several mins of irrigation check with litmus paper placed at inferior fornix
resume irrigate until pH neutralised
check pH 30 mins post irrigation as can rise again
What is hyphema?
Blood in anterior chamber
often associated with trauma
Emergency referral
What is this?
Hyphema
Treatment for hyphema?
Bedrest - so don’t re-disperse blood that has settled
topical steroids
topical cycloplegic agents
admit if young / concerned compliance
Daily exam in 5 days (including IOP)
Sickle cell - pts need more aggressive management on increased IOP
If a pt has hyphema what do you need to asses for ?
orbital compartment syndrome e.g. secondary to retrobulbar haemorrhage
What are the features of orbial compartment syndrome?
Eye pain / swelling
proptosis
‘rock hard’ eyelids
relative afferent pupillary defect
How do you manage orbital compartment syndrome?
Urgent lateral canthotomy (before diagnostic imaging) to decompress the orbit
Orbital wall fractures can causes what?
‘Blow out fracture’ causing damage to the orbital floor and muscle entrapment / fat into maxillary sinus
What ocular muscle does a blowout fracture typically affect?
Entrapment of inferior rectus
pt cannot elevate the eye
How would you investigate blow out fracture?
CT
Causes of blowout fracture
blunt trauma e.g. golf ball,fist knee into eye from a dashboard in car injury
Symptoms of orbital blow out fracture
Periorbital ecchymosis
oedema
inability to elevate the globe
Vertical diplopia
Hypoaesthesia over the distribution of the infraorbital nerve
Depression of the globe
Enophthalmos = sunken in.
