Lecture 17: Management of trauma Flashcards
What is the most common cause of eye-related A&E emergency visits?
Who is more likely to have this?
trauma
men x4
What is a corneal abrasion?
What can cause it?
superficial defects in the epithelium of the cornea
trauma (fingernail, twig, edge of paper, mascara brush)
sub-tarsal foreign body
contact lens-related trauma
trichiasis
What are the predisposing factors of corneal abrasions?
Corneal dystrophy (epithelial basement membrane dystrophy (Cogans)
Diabetes
Neurotrophic keratitis
Corneal exposure
What are the symptoms of a corneal abrasion?
Pain (ranges from mild foreign body sensation to severe pain; may be disproportionate to objective findings)
Photophobia
Blepharospasm
Lacrimation
What are the signs of a corneal abrasion?
Lid oedema
Conjunctival hyperaemia
Corneal epithelial defect
Corneal oedema
Visual loss
May be secondary AC inflammation
How should you clinically assess a corneal abrasion?
Measure VA
Topical anaesthesia to aid examination
Evaluate abrasion with fluorescein
- Size
- Depth
- Confirm no FB present
(evert lid)
Check for AC inflammation
What is the management of corneal abrasion?
Pain control:
-Cycloplegia
-Bandage contact lens
-Lubricants
-Oral analgesia e.g. paracetamol, ibuprofen
Facilitate healing
Infection control
-For large abrasions consider chloramphenicol 0.5% eyedrops or 1% ointment (particularly if contaminated with foreign material)
For large abrasions consider 1% cyclopentolate to reduce ciliary spasm
-arrange follow-up to monitor healing
-refer if deep abrasion or contaminated with foreign metal
-advise on eye protection
-risk of recurrent epithelial erosion sysdrome
What are the symptoms for sub-tarsal foreign body?
What are the signs?
What is the management?
Foreign body sensation
Lacrimation
Hyperaemia
Embedded FB
Corneal FB tracks
-Topical anaesthesia to aid examination
-Remove FB by saline irrigation or saline wetted cotton bud
-Consider prophylactic antibiotic if corneal damage
-Advise on suitable eye protection
What are the symptoms of a corneal foreign body?
What are the signs?
What clinical assessment should you do?
Foreign body sensation
Lacrimation
Blurred vision
Embedded FB
Linear scratches
Rust ring from ferrous material
Determine cause of injury
Measure VA
Rule out multiple particles
Assess depth of corneal foreign body (slit lamp optical section)
Topical anaesthetic may aid examination
How do you remove a corneal foreign body?
-Loose FB can be irrigated with saline
-Conjunctival FB removed with cotton bud
-Assess depth of corneal FB with slit lamp
-Embedded corneal FB should be removed with a hypodermic needle
-Check VA before and after removal
-Evaluate need for antibiotic prophylaxis
How do you use the hypodermic needle?
Hold the needle with the bevel uppermost and horizontally ‘flat on’ to the cornea
Gently lift off the foreign body (FB) from the corneal surface
What is the management of a corneal foreign body?
Do not patch the eye
Consider prophylactic antibiotic if risk of infection
Analgesia
If penetrate into stroma or presence of rust ring then refer to an ophthalmologist
Advise on suitable eye protection
When should you refer a px for trauma?
Reduced VA
Diplopia
Enophthalmos
Raised IOP
Hyphaema-blood
Anisocoria/distorted pupil
Ruptured globe
Vitreous haemorrhage
