ocular trauma Flashcards
what are the classifications of mechanical injuries of the eye (BETTS) ?
open globe or closed globe
open globe is further divided into either rupture or lacerations
lacerations can be caused by : penetrating, perforating trauma or intraocular foreign bodies
closed globe mechanical injuries are further divided into - contusions , lamellar lacerations, superficial bodies
what iis the difference between penetrating and perforating injuries ?
penetrating - enter with no exit
perforating - entry and exit portal
what ocular findings may be associated with penetrating injuries ?
tear drop pupil ( iris prolapse) , the tear drop points towards the corneal injury
corneal tear
scleral perforation
what is the most appropriate management for penetrating trauma ?
prompt surgical repair
pre and post surgical antibiotics
analgesics and anti-emetics
tetanus prophylaxis
in traumatic injuries of the eye what are the possible causes of diminution of vision ?
corneal ulcers
hyphema
lens dislocation
traumatic cataract
vitreous hge
retinal detachement
what. investigations would be required in cases of ocular trauma ?
ocular ultrasound - to viisualize thee posterior segment
Orbital CT
what is the goal of treatment in regards to hyphema ?
to prevent re bleeding
to prevent complications associated with high IOP
what is the treatment protocol for hyphema ?
1-Bed rest in a semi sitting position
2-Daily monitoring of IOP
3-No aspirin or non-steroidal anti-inflammatory drugs 4-Topical steroids to control iritis
5-Topical beta blockers to control IOP
6-Oral aminocaproic acid, an anti-fibrinolytic 50-100 mg/kg/4 hrs. to prevent re-bleeding.
7-Immediate evacuation of the hyphemia if there is increase in IOP or early blood staining in the cornea.
what are the complications associated with ocular blunt trauma ?
fracture floor of the orbit “blow out fracture”
traumatic cataract
Iridodialysis
Corneal abrasions
Lens dislocation
Retinal detachement
what are the bony components of the orbital floor ?
maxillary
zygomatic
palatine
what are the clinical signs and symptoms associated with blow-out fracture ?
reduced vision
soft-tissue swelling - raccoon eyes
surgical emphysema
enopthalmous or proptosis due to retrobulbar hge
diplopia
hypoasthesia below orbital rim
what is thee cause of hypoesthesia below the orbital rim ?
damage to thee infraorbital nerve
what is thee management of blow out fracture ?
ABC - multitrauma
examination - always document VA and RAPD
facial X-ray and CT
broad spectrum ab
tetanus if theres any open wounds
avoid blowing nose ( eye lid swelling on blowing nose )
refer to ophthalmology
what is the clinical image of traumatic cataract ?
rosette shaped cataract
what is iridodialysis ?
seperation of the attachement of the iris form the ciliary body , resulting in a d shaped pupil
what is the mgmnt for iridodialysis ?
cover the defect with coloured contact lenses
close the defect , suture the iris to the limbus
what steps are important when assessing FB in the eye ?
visual acuity must be tested first
always flip the eye lid
sit lamp exam must be done
corneal fluorsceine staining
when is urgent referral to an ophthalmologist needed ?
only in penetrating lesions or in cases of suspected infections
what are the signs observed in siderosis bulbi and what is the
treatment ?
in the event of toxic effect of iron :
in the cornea : krukenberg spindle
lens : siderotic catarcat
iris and CB : atrophic changes , mydriasis
heterochromia
treatment : removal off the FB
what is the presentation of chalcosis bulbi ?
toxic side effects of copper
cornea - KF rings
lens - sunflower cataract ( true cataract )
what is the technique of removal for FB in the eye ?
topical anesthetic first - oxybuprocaine
approach eye from the side to avoid initiating the blink reflex
remove thee FB with a cotton tip
prescribe ointment and quinolone 4 times a day along with padding of the eye
follow up thee next day
most seriious chemical burn ?
alkali burns
what is the presentation of severe exposure to chemical injuries ?
conjunctival and episcleral whitening ( coagulative necrosis )
corneal oedema and opacification
severe iritis
secondary glaucoma
Posterior segment destruction
what is the management in chemical injuries ?
immediate copious irrigation of the eye with plain water or saline irrigation
in severe exposure :
debridement of necrotic tissue
gloss rod lysis of symblepharon
avoid topical steroids if thee corneal epithelium is not intact
what kind of imaging is contraindicated in FB ?
ferrous metallic FB should never undergo MRI
what are the protective mechanisms of the eye ?
corneal sensation
tear fluid
eyelids and eyelashes
bony orbit
cushioning by surrounding fat
neck withdrawal reflex
constriction of the pupil to strong light
