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Ophthalmology > Occular trauma > Flashcards

Occular trauma Flashcards

1
Q

Go over the anatomy of the eye

A
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2
Q

What are the main mechanisms for occular trauma occurring ?

A
  • Blunt trauma
  • Penetrating trauma
  • Burns e.g. chemical or physical
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3
Q

What are the main male and female mechanism of injury to the eye?

A
  • Male mechanisms – Assualt / machinery
  • Female mechanism – Falls at home
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4
Q

Define what is meant by an eye wall injury

A

Eye wall injury = injury restricted to the sclera and cornea:

  • Closed globe injury: eye wall wound is not full-thickness.
  • Open globe injury: full-thickness wound of the eyeball (wound occurs at the impact site by an outside-in mechanism).
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5
Q

Define what is meant by a contusion of the eye

A

There is no full-thickness wound; injury is due to direct energy delivery by the object (eg, choroidal rupture) or to changes in the shape of the globe.

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6
Q

Define what is meant by a rupture of the eye?

A
  • This is a full-thickness wound of the eye wall caused by a blunt object
  • Note - since the eye is filled with incompressible liquid; the impact causes momentary increase in intraocular pressure (IOP) and the eye wall gives at the weakest point, which may be the impact site,or elsewhere.
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7
Q

Define what is meant by a Intraocular foreign body (IOFB) injury

A
  • Retained FB which caused entrance laceration.
  • This is technically a penetrating injury but the clinical implication is different, so it is grouped separately
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8
Q

Define what is meant by a penetrating injury to the eye

A

This is single laceration of the eyeball, usually caused by a sharp object.

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9
Q

Define what is meant by a perforating injury to the eye

A

Two full-thickness lacerations (entrance and exit) of the eye wall, due to a sharp object or missile - both wounds caused by the same agent

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10
Q

What are the golden rules regarding assessing occular trauma ?

A
  1. Good history is key
  2. Always record visual acuity - using snellen chart
  3. Examination of the eye - orbit & lids, conjunctiva, cornea, anterior chamber, iris & pupils, fundus
  4. Test movements of the eye & do visual fields
  5. Test pupil reactions + for RAPD
  6. Do flurosciene drops to identify any epithelial loss
  7. Handle suspected globe ruptures with care
  8. X-ray orbits if suspicion of an intraocular foreign body
  9. Immediate irrigation of chemical injuries (the solution to pollution is dillution)
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11
Q

What do you need to remember to test regarding someones vision following occular trauma ?

A

Visual acuity

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12
Q

Describe the typical presentation of chemical injuries to the eye

A
  • Pain, blurring, photophobia, foreign body sesnation
  • Blepharospasm, red eye, cloudy cornea
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13
Q

What are the common causes of acid chemical injuries to the eye ?

A
  • Sulfuric acid (car batteries)
  • Sulfurous acid (bleach)
  • Acetic acid (vinegar)
  • Hydrocholric acid (swimming pools)
  • Hydrofluoric acid (glass polishing)
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14
Q

What are some of the common alkali causes of chemical injuries to the eye ?

A
  • Ammonia (fertilisers, refridgerants)
  • Potassium hydroxide
  • Sodium hydroxide (drain cleaners, car airbags)
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15
Q

What is the key management of chemical injuries to the eye ?

A
  • The 3 I’s - Irrigate, Irrigate, Irrigate - using a minimum of 2L of NaCl (saline) solution or until pH is normal
  • pH testing should be done & once normal pH of the eye (7.4) is achieved the eye can then be exammined using slit lamp
  • Also check toxobase if available
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16
Q

How is the severity of chemical injuries to the eye graded?

A
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17
Q

What are the stages of corneal scarring which occurs due to chemical injuries to the eye ?

A
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18
Q

What are the common causes of blunt trauma to the eye ?

A

Variety of ways e.g. sports balls, elastics snapping back, champgne corks or through fights e.g. a punch

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19
Q

List the main injuries seen caused by blunt trauma to the eye

A
  • Blow-out fractures
  • Traumatic uveitis
  • Hyphema
  • Dislocated lens
  • Retinal detachment
  • Chorodial tear
  • Commito retinae
  • Optic nerve avulsion
  • Posterior vitreous detachment
  • Globe rupture
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20
Q

How does blunt trauma injuries to the eye usually present ?

A
  • Severe pain
  • Photophobia
  • Blurred vision or diplopia
  • Corneal epithelial defect
  • Conjunctival hyperaemia (dilatation & redness of conunctival vessels)
  • Slit lamp may reveal corneal oedema or abrasions. Hyphema may also be present
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21
Q

What does hyphema presence following blunt trauma to the eye indicate ?

A

It indicates that the eye has suffered significant injury & structures within the anterior & posterior segment are likely to be injured

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22
Q

What is a blowout fracture ?

A
  • This is a fracture through any of the orbital walls, with an inferior (maxilla) fracture being most common
  • IR muscle may also prolapse through the fracture (this may cause IR muscle prolapse)
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23
Q

What are the signs/symptoms of a blowout fracture ?

A
  • Periorbital oedema & echymosis (bruising)
  • Enophthalmus
  • Diplopia
  • Restricted or painful eye movement
  • Altered sensation over the cheek, upper lip or upper gingiva
  • Proptosis - suggestive or orbital haematoma
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24
Q

What is traumatic uveitis ?

A

This is uveitis, caused by trauma to the eye (it is an uncommon cause of uveitis)

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25
Q

What is shown in this pic ?

A

Traumatic uveitis - note the circumcorneal red eye

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26
Q

What is hyphema ?

A
  • This is a pooling/collection of blood in the anterior chamber of the eye (between cornea & iris)
  • This is seen as visible blood in the front of the eye
27
Q

What is the appearance of lens disolcation ?

A

The edge of the subluxed or disolcated lens may be visualised on slit lamp

28
Q

For retinal detachment & vitreous haemorrhage & PVD refer to visual loss - haemorrhage notes

A
29
Q

What is a chorodial rupture ?

A

This is a splitting or break in the choroid in the back of the eye. Caused by trauma to the eye

30
Q

What are the features of a chorodial tear?

A

May experience a decrease in vision or may be asymptomatic

31
Q

What is usually the management of a chorodial tear?

A

Conservative

32
Q

What is commito retinae ?

A

This is bruising/swelling of the retina

33
Q

What are the characterisitic features of commito retinae ?

A
  • Blurry vision or vision loss
  • Intraretinal haemorrhages & mottling (have a grey/red appearance)
34
Q

What is optic nerve avulsion ?

A

This is a rare occurence where blunt trauma causes a tear & detachement of the optic nerve from the globe

35
Q

What are the clinical features of optic nerve avulsion ?

A
  • Sudden complete vision loss
  • No light perception in the eye
  • RAPD
  • On fundoscopy pale disc is seen due to nerve being detached from the eye
36
Q

What are the clinical features suggestive of globe rupture ?

A
  • Pain & decreased vision
  • Hyphema
  • Loss of ant. chamber depth
  • Tear drop pupil if caused by laceration
  • Severe subconjunctival haemorrhage completley encircling the cornea
  • Positive seidels test
  • IOP ≤ 5
37
Q

What is retrobulbar haemorrhage ?

A
  • An occular emergency which can occur from trauma (or surgery)
  • Bleeding in the orbital cavity compresses orbital structures causing ischaemia of the eye & optic nerve
38
Q

What are the clinical features of retrobulbar haemorrhage ?

A
  • Severe eye pain
  • Progressive visual loss
  • Progressive ophthalmoplegia (paralysis of extraocular eye muscles)
  • +/- eyelid bruising, reduced pupillary response, a tense eyeball & pallor ot venous dilatation of optic disc
39
Q

What is an open glove (penetrating) eye injury ?

A
  • This is an injury which pentrates the cornea or sclera
  • A penetrating injury may not be visible & is sometimes suspected on history alone
40
Q

What are the features suggestive of a open globe injury?

A
  • History of sharp/high velocity injury
  • Deep eyelid laceration
  • Distorted globe
  • Sub-conjunctival haemorrhage
  • Conjunctival laceration
  • Black protruding uveal tissue
  • Distorted iris or pupil ‘tear-drop shaped pupil’
  • Hymphema
  • Loss of IOP
  • Shallow ant. chamber
  • Pos seidels test
41
Q

What is shown in this pic ?

A

A penetrating orbital injury

42
Q

What is shown in this pic ?

A

Eyelid laceration

43
Q

What is shown in this pic ?

A

Scleral laceration

44
Q

What is shown in this pic ?

A

Corneal laceration

45
Q

What are the main truama injuries to the cornea ?

A
  • Corneal abrasion
  • Corneal foreign bodies (FBs)
  • Corneal lacerations/penetrating corneal injury
46
Q

What are corneal abrasions (partial-thickness) often caused by ?

A

Minor trauma e.g. scratch, grit or contact lens

47
Q

What are corneal lacerations (full-thickness corneal injuries) sometimes associated with ?

A

Intra-ocular foreign bodies (IOFB)

48
Q

What are the symptoms suggestive of a corneal abrasion or a corneal FB ?

A
  • Redness (conjunctival)
  • Eye pain
  • Watering
  • Blurred vision (decrease VA in affected eye)
  • Photophobia
  • Pain on eye movement
  • Foregin body sensation
49
Q

What are the signs of a corneal abrasion ?

A
  • Conjunctival injection (redness)
  • Epithelial defect (yellow stained abrasion) seen with fluorscein
50
Q

What are the signs of a corneal FB?

A
  • Visible FB
  • Rust ring esp if a ferrous FB has embedded for hrs or more
51
Q

What are the signs/symptoms of a corneal laceration/penetrating injury?

A

That of open globe injuries

52
Q

What is sympathetic ophthalmia ?

A
  • This is where a penetrating injury to one eye results in exposure of the body to intra-ocular antigens
  • This provokes an auto-immune reaction in both eyes
  • Which can then lead to blindess in both eyes
53
Q

When should sympathetic ophthalmia be suspected ?

A

Any inflammation of the uninvolved eye following trauma (penetrating injury) to the fellow eye should warrant concern of its development

54
Q

List the different locations a FB may affect the eye

A
  • Sub-taral
  • Conjunctival
  • Corneal
  • Intra-ocular
  • Intra-orbital
55
Q

What are the symptoms of FB’s?

A
  • Decreased vision
  • Diplopia
  • May have no symptoms
56
Q

What type of FB is shown ?

A

Sub-tarsal FB

57
Q

What type of FB is shown ?

A

Conjunctival FB

58
Q

What type of FB is shown ?

A

Corneal FB

59
Q

What type of FB is shown ?

A

Ant. chamber FB

60
Q

What features are more suggestive of a FB being intra-ocular (penetrating)?

A
  • Irregular pupil
  • Shallow ant. chamber
  • localised cataract
  • gross inflammation
61
Q

What activites are IOFB’s often caused by?

A

Same as corneal lacerations/penetrating injuries & globe rupture i.e. activites involving fast moving particles e.g. hammering, chiseling

62
Q

What Ix should always be done if a IOFB is suspected?

A

X-ray of the orbit

63
Q

What is the Mx of FB’s?

A
  • Slit lamp
  • Local anaesthetic
  • Use edge of a needle to scrape or scoop it out
  • COver area after with chloramphenicol ointment
64
Q

What are the key ways to prevent occular trauma ?

A
  • Ensure safe practices (training) & upto date machinery
  • Protective eye wear
  • Clear rules & education

Ophthalmology (23 decks)

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