Managing Trauma Flashcards
What is the most eye related ED visits?
- Traumatic injuries, Especially men (DIY, sports ect)
- Mainly, periorbital, corneal abrasions or foreign body
What are corneal abrasions?
Normally superficial defects in the epithelium of the cornea.
What can cause corneal abrasions?
- Trauma
- Sub-tarsal foreign body
- CL trauma (mainly damage by new users taking lens in and out)
- Trichiasis (eyelashes growing inwards)
What are predisposing factors of corneal abrasion?
- Corneal dystrophy
- Diabetes( fragile epithelium)
- Neurotrophic keratitis (loss of the sensory nerves in the cornea)
- Corneal exposure
What is an example of a corneal dystrophy?
Cogans dystrophy . This looks like a map -dot fingerprint.
What symptoms do you get with CA?
- Pain (the surface has millions of sensory neurons!)
- Photophobia (more of a light sensitivity, not like photophobia in uveitis)
- Blepharospasm
- Lacrimation
Why does it blepharospasm make it harder for us to see behind the slit lamp?
The eyes are more so closed.
What signs can we see with CA?
- Lid oedema
- Conjunctival hyperaemia (red eye)
- Corneal epithelial defect which we can see under white light
- Corneal oedema - because the epithelial is broken down oedema will manifest
- Visual loss - more central = more likely to impact.
- Possible mild AC inflammation ; cells and flare
What history do we take with CA?
- When
- What caused it?
- Associated symptoms
- Previous treatment
Why might we use topical anastetic?
To help with the blephaspasms. And help open the eye up, to do a white light and fluorescence slit lamp.
What do we need to evaluate using the SL?
- Size
- Location
- Depth
- IS there a FB?
- AC inflammation.
How can we manage a px with CA?
- Controlling pain
- Preventing secondary infection
- Facilitate healing.
Why might cycloplegics help with reducing pain?
It will stop ciliary spasm, which causes pain.
Should we patch or not for CA?
A review showed there was no diffrence between patching and not patching. In fact it hinders the px, as they lose steriopsis
How can we manage the pain with CA?
- Cycloplegia
- Bandage CL
- Lubricants
- Oral analgesia’s like paracetamol
- Topical NSAID (diclofenac sodium)
Should we be using NSAIDS for pain relief with CA?
A review showed there was not strong enough evidence to use NSAID, THUS using oral analgesia’s is more cost effective
How can we use antibiotics?
Small lesions, there is no need. However if larger we can use,
1. Chloramphenicol 0.5% drops or 1% ointment
So in conclusion how do we manage?
- Analgesia
- No patching
- Follow up appointment
- Refer for deeper abrasion or contaminated foreign material (dirty screw)
- Advise eye protection
- Educate on Recurrent epithelial erosion syndrome
What is recurrent epithelial erosion syndrome?
The CA does not fully heal. The px will feel pain on awakening and the px needs to be educated on this.
What is sub-tarsal foreign body and how does it come about?
The foreign body sticking to the tarsal plate!
1. Particle falling into the eye (DIY)
2. Wind blowing it into the eye (cycling)
What are the symptoms?
- FB sensation
- Lacrimation (watery eye)
What are the signs for STFB?
- Hyperaemia
- Embedded FB
- Corneal FB tracks.
Why do we get corneal FB tracks?
The FB will scratch the cornea as the eye moves
How do we manage STFB?
- Use a wet (saline solution) cotton bud to remove it. Use a topical anaesthetic.
- Make judgement if the px needs prophylactic
- Advise px on wearing eye protection
How can someone get a corneal abrasion from FB?
- Wind blowing
- DIY
- High velocity (hammering and grinding, which can generate high moving particles)
What are the symptoms of corneal abrasion from FB?
- FB sensation
- Lacrimation
- Blurred vision depending on location ect
Why might a px report pain on upper eye when the FB is in the middle?
The eye can detect pain well, but it is not very good at accurately locating where the pain is coming from
What are the signs of FB?
- Embedded FB
- Linear scratches
- Rust ring from the ferrous material.
What does a rust ring look like?
What do we need to do behind the slit lamp?
- Rule out multiple FB
- Assess the depth of the FB
- Topical anaestics can aid the routine behind SL (blephospasm)
How can we remove FB?
- Loose FB can be taken out using irrigation using saline
- If on conjunctiva use a cotton bud
How do you remove an embedded corneal FB?
Using a hypodermic needle. It is difficult and we need to consider if we can do it or refer.
1. Hold the needle horizontally to the cornea with the bevel upper - this minises the risk of penetraing the cornea 2. Gently life of the FB from the cornel surface. WATCH THIS IT IS ON MOODLE
What should we do once taken out?
Check VA after the removal as well
Summarising the CFB management:
- No eye patch
- Consider prophylactic antibiotic
- Analgesia
- If penetrating stroma or rust ring then refer emergency
- Advise eye protection
How do blunt traumas come about?
- Sport
- Road traffic accident
- Assault
What do mild cases look for blunt traumas?
- Eyelid swelling
- Bruising
- Sub-conjunctival haemorrhage
- Corneal abrasion
What do severe blunt traumas look like?
- Blow out fracture
- Hyphema : google this image, it looks like hypopyon but with blood.
- Raided IOP ; use the other eye as a control to measure this
- Iridodialysis : the iris breaks away
- Commotio retinae ; the retina bruises and looks pale
- RD
What clinical assessments do we need to do?
- Detailed H and S
- VA
- OM
- IOP
- Pupils
- Anterior and posterior(dilated) eye exams
What are some red flag referrals?
- Reduced VA
- Diplopia
- Enopthalmos ; flow out fracture
- Raised IOP
- Hyphaema (blood in aq)
- Anisocoria / distored pupil
- Ruptured globe
- Vitreous haemorrhage
What does endopathalmos look like?
What does Hyphema look like?
NOTE: Topical corticosteroids may reduce associated inflammation,
Topical cycloplegic agents are also useful for patients with significant ciliary spasm or photophobia.
What does irdiodialysis look like?
The iris breaks away, due to a severe blunt injury
WHat does commotio retinae look like?
Retina looks bruised and pale ; severe blunt trauma cause
