Ocular Trauma

Question 1

What is the classification of ocular trauma

Answer 1

MECHANICAL INJURY
- Closed globe injury
- Open globe injury

NON-MECHANICAL INJURY
- Chemical injury
- Thermal injury
- Electrical injury
- Radiation injury

Question 2

What is a closed globe injury?

Answer 2

An injury with No full-thickness wound of eye wall (sclera and cornea)

Question 3

What is an open globe injury?

Answer 3

An injury with full-thickness wound of the eye wall (sclera and cornea)

Question 4

List the possible clinical features of blunt trauma

Answer 4

• Retrobulbar hemorrhage
• Ecchymosis
• Laceration
• Canalicular laceration
• Globe rupture
• Hyphaema
• Sphincter tear
• Traumatic cataract
• Commotio retinae (from traumatic retinopathy)
• Subretinal hemorrhage
• Optic nerve avulsion

Question 5

Extra ocular retained foreign objects are objects that are retained in the?

Answer 5

Conjunctiva
Cornea

Question 6

Intraocular foreign body can cause damage by

Answer 6

Mechanical effect
Reaction to foreign body
Introduction of infection

Question 7

How would you manage a case of foreign body in the eye?

Answer 7

There is immediate and follow up management.

IMMEDIATE
- History
- Examination
- Investigations (ultrasound, plain X-ray, CT scan)
- Manage symptomatically
•Topical antibiotics, steroids and cycloplegia
•Avoid ointment in penetrating or perforating eye injury
•Tetanus vaccination
•A broad-spectrum oral antibiotic - to avoid orbital cellulitis
•Analgesics
•Intraocular pressure lowering agents

Question 8

What is the difference between Pure Blow out orbital fracture and Impure Blow orbital fracture

Answer 8

a ‘pure’ blow-out fracture does not involve the orbital rim whereas an ‘impure’ fracture involves the rim and/or adjacent facial bones.

Question 9

Treatment of orbital fracture

Answer 9

Can be;
CONSERVATIVE if any of these conditions is seen
•Small cracks
•Fractures involving up to one-third of the orbital floor with little or no herniation
•No significant enophthalmos
•Improving diplopia

•Antibiotics, ice packs and nasal decongestants
•patient is instructed not to blow the nose because of the possibility of forcing infected sinus contents into the orbit

SURGICAL if any of these conditions is seen
•Entrapment of orbital content
•Oculocardiac reflex
•Enophthalmos greater than 2 mm
•Persistent and significant diplopia

Question 10

How do you treat chemical injuries?

Answer 10

• Immediate and thorough wash with clean water or saline
• Removal of contaminant such as lime, contaminated and necrotic tissue
• Topical medications - topical tropicamide or atropine, corticosteroids(not used after one week) and antibiotics
• Prevention of symblepharon (a pathologic condition where the bulbar and palpebral conjunctiva form an abnormal adhesion to one another) by using a glass shell or sweeping a glass rod in the fornices twice daily

Treatment of complication
•Secondary glaucoma - topical 0.5 percent timolol instilled twice a day and oral acetazolamide 250 mg 3-4 times a day.
•Corneal opacity may be treated by penetrating keratoplasty
•Symblepharon – symblepharectomy
•Skin grafting
•Surgery for ectropion or entropion due to scarring

Question 11

How would you manage thermal injuries

Answer 11

It is usually caused by fire or hot fluids. They present with
•Eyelid burns
•Loss of eyelashes
•Conjunctiva hyperaemia
•Cornea oedema

Treatment
•Antibiotics, analgesics, topical NSAIDS
•Treat burns areas

Question 12

What are the injuries that can arise from thermal injuries

Answer 12

Maculopathy
Cataract
Photophthalmia
Keratoconjuctivitis
Dermatitis of lids
Macular burns