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Ophthalomology > Eye Trauma > Flashcards

Eye Trauma Flashcards

0
Q

When examining eyelid trauma

A

Check visual acuity - also for bony injury to the orbit and eye
Location, depth and length of laceration
Any damage to the lid margin or lacrimal drainage
Lid viability and position
Orbicularis function or lagophthalmos

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1
Q

Eyelid trauma

A

Common
May be due to laceration, blunt or chemical trauma
Important to record the time and cause
Note - pain, other injures, change in vision and watery eyes

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2
Q

Lagophthalmos

A

Inability to fully close the eye

May be secondary to trauma or nerve injury

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3
Q

Treatments of eyelid laceration

A

Suture with 6/0 vicryl or nylon and remove sutures after 7 days
If the margin or lacrimal ducts involved refer to ophthalmoscopy
If lids do not close protect cornea with topical lubricants (Oc lacrilube 6/day) or tape lid shut
Consider tetanus prophylaxi

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4
Q

Prognosis of eyelid trauma

A

Lacerations not involving the lid margin heal well
Skin contraction may cause ectropian - manage with surgery
Damage to lid margin/lavator/medial canthus may cause epiphora
Damage to levator muscle may cause ptosis
Lid trauma can bruise extensively

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5
Q

Corneal abrasion

A

Common - due to fingernails, contact lens or foreign bodies
Present with pain, photophobia, watering and foreign body sensation
Signs - swollen eyelid, conjunctival injection and corneal lesion which stains with fluorescein

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6
Q

Ectropian

A

Lower eyelid turned outwards

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7
Q

Epiphora

A

Watery eye

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8
Q

Investigation of corneal abrasion

A

Nature of foreign body -> organic, metallic -> googles next time
Investigate with slit lamp (or ophthalmoscopy with +ve lens to provide magnification) + fluorescein –> note size, shape, depth
Invert lid to check FB isn’t trapped under it
Check for bacterial keratitis -> particularly in lens water

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9
Q

Bacterial keratitis

A

Bacterial infection of the corneal

Causes corneal ulcer

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10
Q

Treatment of corneal abrasion

A

Cease contact lens use
Topical antibiotics
May need NSAIDs for pain relief
Pt to return if not settled in a couple of days

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11
Q

Foreign bodies (subtarsal/corneal)

A

Metal is most common
May stick to cornea or lodge under the upper eyelid -> beware intra ocular FBs
Microbial keratitis may follow

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12
Q

Symptoms of FB

A 
Blurred vision
Photophobia
Pain
FB sensation
Watering
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13
Q

Signs of FB

A

‘Rust ring’ can form after 48 hours with metal object
White corneal infiltrate may indicate bacterial keratitis
Linear vertical fluorescein staining on superior corneal suggests subtarsal FB
May have to anaesthetise eye to examine

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14
Q

Management of FBs

A

Remove under topical anaesthesia with moist cotton bud
Small or multiple FBs can be removed using saline irrigation
Prescribe chloramphenicol eye drops QDS for a week
Embedded FBs refer to ophthalmology
Otherwise advise pts to return if symptoms last over 48hrs

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15
Q

Eye injuries from trauma

A

Penetrating injuries - have an entrance wound only
Perforating injuries - entrance and exit wound
Intraocular FBs - important not to miss, due to metal striking metal

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16
Q

Hx of eye trauma

A

Determine nature of injure - speed of impact
Hammering/drilling high speed with greater risk of penetrating injury then slower grinding
Small fragments may enter eye without obvious trauma
Ferrous FBs can cause siderosis

17
Q

Siderosis

A

The leak of toxic ions into the eye which are retinotoxic and impair retinal function irreversibly

18
Q

Signs and symptoms of trauma

A

Symptoms - painful eye, reduced acuity, may be asymptomatic

Signs - may have entrance wound, but this can be obscured by haemorrhage, ocular inflammation, pupil distortion, reduced red reflex

19
Q

Complications of eye trauma

A

Iris prolapse
Cataract
Endophthalmitis

20
Q

Investigations of eye trauma

A

X-rays useful - specific techniques avaliable to establish if FB is intraocular
CT if high suspicion but MRI is contraindicated if poss metal
Eyelid eversion to rule out subtarsal FB, corneal exam with fluorescein

21
Q

Treatments of traumatic/penetrating eye injury

A

Refer, protect the eye with a shield and poss admit for surgery
Corneal repair with nylon or cyanoacrylate glue and bandage Lens over the surface
Oral antibiotics to reduce risk of endophthalmitis

22
Q

Endophthalmitis

A

Intraocular infection

A serious complication of eye injury

23
Q

Ruptured globe

A

Burst eyeball
Blunt trauma, often sports injures or fights
Presents with pain and reduced acuity
Determine cause and tetanus state

24
Q

Signs of a ruptured globe

A

Severe sub-conjunctival bleed - Hyphaema - vitreous bleeding
Restricted movement/Diplopia
Collapsed eyeball with extruded contents - irregular pupil and subluxed lens
Traumatic optic neuropathy, retinal breaks and commotio retinae

25
Q

Hyphaema

A

Blood in the anterior chamber

26
Q

Commotio retinae

A

Retinal oedema as a result of blunt trauma

27
Q

Examination of a ruptured globe

A

Test acuity, examine corneal (fluorescein) and ant structures with slit lamp
Pupil irregularities and traumatic cataract
Test optic nerve (RAPD)
Absent or reduced red reflex

28
Q

Treatment for a ruptured globe

A

Refer and admit for ophthalmology specialist treatment
Protect eye with shield
Nil by mouth and update tetanus vac if needed

29
Q

Chemical injury to the eye

A

Common and dangerous
Need to know the type of chemical and the time since it happened
Check acuity, lids, conjunctiva and cornea

30
Q

Severe alkali injures can cause

A

Closure of conjunctival vessels so that the eye appears deceptively white and un-inflammed

31
Q

Types of chemical eye injury

A

Alkalis (most harmful) - caustic soda/potash (sodium hydroxide)
Ammonia, lime or wet cement and mortar, lye, wet plaster
Acids - car batteries, hydrochloric acid, acetic acid
Solvents, Detergents or irritants (mace)

32
Q

Treatments of chemical eye injury

A

Immediate irrigation - test acuity/refer to ophthalmology only after irrigating with saline and everting both eyelids to maximise effect
For alkali/acid burns irrigate for 30mins - don’t try to neutralise
Measure pH of chemical and eye after every 10mins of irrigation
Continue until pH is normal
Anaesthetise if possible

33
Q

Traumatic optic neuropathy

A

May be unilateral or bilateral
Damage to the optic nerve, often indirect due to blow to the head, face or orbit.
Soft tissue swelling may cause compressive optic neuropathy

34
Q

Signs and symptoms of traumatic optic neuropathy

A

Rapid loss of vision - can be no light perception - RAPD
May also occur as colour or visual field defect
Optic nerve may be initially swollen and subsequently atrophy
Examine - acuity, colour, motility, fields, pupils, eye and the orbit

35
Q

Investigations and management of traumatic optic neuropathy

A

Urgent CT to rule out fracture or haemorrhage

Refer to ophthalmology

36
Q

Orbital fracture

A

Most commonly a ‘blowout’ fracture of the orbital floor following a punch - establish the cause and time
Document well for legal reasons
Ask about Diplopia, visual disturbance and infra orbital numbness

37
Q

Symptoms and signs of orbital fracture

A

Symptoms - pain which is worse on looking up, Diplopia and eyelid swelling
Signs - restricted eye movements, nose bleed, eyelid oedema, infra-orbital numbness

38
Q

Examination of orbital fractures

A

Look for enophthalmos - retraction of the globe due to herniation of tissue into the maxillary sinus
Test acuity, pupils, colour vision and ocular motility
Examine the eye for injury, including fundoscopy

39
Q

Management of orbital fracture

A

X-ray can show blood fluid level in maxillary sinus - CT if sure
If confirmed or suspected refer to ophthalmology

Ophthalomology (11 decks)

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