Ocular Trauma Flashcards
Göze Künt Travma; hastanın gözüne tenis topu çarpmış. Hifema resmi vardı (anterior kamarada Kan çökmesi).
Komplikasyonları nedir?
Göz içi basıncı düşürmek için tedaviler (hangi şekilde verilir, IV/oral formu Türkiye’de var mı)? Hastanın kanaması var ne yapacaksın; Hastaya başka ne dersin?
➢ Untreatable visual loss if a retinal hole
develops at the fovea
➢ Makulanın oradaki koroid hasar alırsa vision bozulabilir.
➢ Kozmetik ve okulomotor problemler
➢ Hifema, sonrasında RBC glokom (medikal tedavi). Ayrıca siliyer body rüptüre olmuşsa angle recession glokom çıkabilir (medikal ve trabekulektomi).
√ Hastanın şikayetleri neler olur? The symptoms relate to the etiology. Pain secondary to trauma or surgery may be experienced by the patient. However, less pain is reported than expected from a severely elevated IOP. Patients with high IOP may also present with blurry vision, headache, brow ache, nausea and/ or vomiting.
➢ Hastanın kanaması olduğu için anterior chamber washout (irrigation)
➢ Kornea boyanmasın diye hasta geri yatmayacak, ayakta uyuyacak.
➢ Do not blow out your nose
Blunt trauma to the globe; complications of ant. and post. segment
➢ Anterior Segment Complications
➢ Corneal: abrasion, Acute corneal oedema
➢ Hyphaema(~~ant chamberda kan)
➢ Transient miosis
➢ Iridodialysis – irisin siliyer korpusdan ayrılması
➢ Cataract
➢ Lens subluxation/dislocation
➢ Posterior Segment Complications
➢ Posterior vitreous detachment
➢ Commotio retinae (~~trauma)
➢ Choroidal rupture
➢ Optic nerve avulsion
Kimyasal Yanık; kimya mühendisi gözünü yakmış.
* Neler görmeyi beklersin?; tx?
➢ Necrosis of the conjonctival and corneal epithelium, loss of limbal stem cells,
➢ Stromal corneal opacification
➢ Iris, lens damage
➢ Ciliary epithelial damage impairs secretion of ascorbate
➢ Hypotony and phthisis bulbi – şeklinin bozularak küçülmesi deforme olması
tx:
Acil müdahale
➢ Copious irrigation – bol yıkama
➢ Irrigate under the upper and lower lid to remove solid particles (double eversion of the eyelids)
➢ Dilating agents, ağrı kesiciler
➢ Debridement of necrotic areas
➢ Medikal:
√ Steroids (first 7-10 days)
√ Ascorbic acid (hem oral hem topical)
√ Tetracyclines (antikolajenaz olarak, sistemik ve topical)
➢ Cerrahi
➢ Limbal stem cell transplantation
What are different types of trauma to the globe?
o Closed injury: corneoscleral wall of the globe is intact
o Open injury: involves full-thickness wound of the corneoscleral wall
o Rupture: full-thickness wound caused by blunt trauma
o Laceration: full-thickness wound caused by a sharp object
o Penetration: a single full-thickness wound
usually caused by a sharp object without an exit wound
o Perforation: two full-thickness wounds, one entry and one exit
What are signs of blow-out orbital fracture?
sudden increase in the orbital pressure by a striking object which is greater than 5 cm in diameter
Signs: Ecchymosis, oedema, subcutaneous emphysema
Infraorbital nerve anesthesia
Diplopia
Enophthalmos
Ocular damage
How is blow-out orbital floor fracture treated?
-The patient should be instructed not to blow the nose!!! (d/t microorganisms)
- Initial treatment is conservative with antibiotics if the fracture involves the maxillary sinus.
- Prevention of vertical diplopia and/or cosmetically unacceptable enophthalmos.
Fracture size
Herniation of orbital contents
Muscle entrapment
What is SYMPATHETIC OPHTHALMITIS?
o is a very rare, bilateral, granulomatous panuveitis which occurs after penetrating ocular trauma usually
associated with uveal prolapse. o Traumatized eye = exciting eye
o The fellow eye = sympathizing eye
o Presentation is between 2 weeks and 3 months after initial injury (90% within the first year)
o Exciting eye shows evidence of initial trauma, red, irritable
o Sympathizing eye photophobic and irritable.
o Chronic granulomatous anterior uveitis with iris nodules and mutton fat keratic precipitates.
o Optic disc swelling and multifocal choroiditis. o Treatment = systemic steroids
o Long term prognosis is good.
