Ocular Trauma

Question 1

What is contusion?

Answer 1

Closed globe, blunt trauma

Question 2

What are the signs of contusion?

Answer 2

Subconjunctival haemorrhage
Bruising
Lid Swelling
Hyphaemia

Question 3

What can cause contusion?

Answer 3

Fights
Falls
Sports
Flying objects

Question 4

What is the prognosis for contusion if there is no blow-out fracture?

Answer 4

Self limiting
1-2 weeks of healing

Question 5

What is the prognosis for contusion if there is a blow-out fracture?

Answer 5

Depends on severity
May need surgery
May cause BV issues if EOMs become trapped

Question 6

What are some secondary complications of a blow-out fracture?

Answer 6

Commotio retinae
Conjunctival chemosis
Vitreous haemorrhage
RAPD
Macular hole
Uveitis
Iridodialysis
Corneal erosion
Lid laceration

Question 7

What is a lamellar laceration?

Answer 7

Cut caused by a foreign body

Question 8

What can cause a lamellar laceration?

Answer 8

Flying objects
Nails
DIY

Question 9

What are the signs of a lamellar laceration?

Answer 9

Redness
Epiphora
Lots of pain

Question 10

How can you check under the upper lid for an FB?

Answer 10

Double eversion test

Question 11

What can cause an electric trauma?

Answer 11

Lightning strike
High-voltage electric shock

Question 12

What damage can occur from electric trauma?

Answer 12

Cataract
Macular hole
Irreversible ON damage
Corneal damage - usually resolves

Question 13

What could cause a globe rupture?

Answer 13

V high pressure injury (e.g. hitting corner of a table) causing scleral failure

Question 14

What investigations should be performed for a globe rupture?

Answer 14

CT scan

Question 15

What investigations should NOT be performed for a globe rupture?

Answer 15

MRI scan
Ultrasound
No ketamine in anaesthetics

Question 16

What is the prognosis for globe rupture?

Answer 16

Very poor
Usually enucleation

Question 17

What is a perforating laceration?

Answer 17

The causative agent is no longer in the eye - may be some fragments
Entry and exit wound can be the same or different

Question 18

What can a perforating laceration cause?

Answer 18

V low IOP (1-2mmHg), causing globe shrinkage
Macula and ONH damage
Traumatic cataract
Endophthalmitis
Leaking aqueous humour

Question 19

What test can check for leaking aqueous?

Answer 19

Seidel’s test - fluorescein instilled and blue light applied, any leakage will flouresce

Question 20

What is a penetrating laceration?

Answer 20

Causative agent still in eye

Question 21

What should you do with a penetrating laceration?

Answer 21

Do not try to remove
Do not put a shield on

Question 22

What complications may a copper FB cause?

Answer 22

Maculopathy
Retinal toxicity
Vitreous changes

Question 23

What complications may an iron FB cause?

Answer 23

Cataract
OAG
Retinal Detachment
Iris atrophy
Pigmentary changes

Question 24

What complications may a vegetative FB cause?

Answer 24

Fungal keratitis
Endophthalmitis

Question 25

What complications may a human bite cause?

Answer 25

Fulminant infection

Question 26

What types of damage can chemical irritants cause?

Answer 26

Corneal epithelial defects, oedema and haze V high dose: corneal endothelial damage and neovasc

Question 27

What is an example of a chemical irritant?

Answer 27

Tear gas

Question 28

What are some examples of an alkali that can cause damage?

Answer 28

Ammonia (toilet cleaners) Plaster lime Sodium hypochlorite (bleach)

Question 29

What damage can alkalis cause?

Answer 29

Kills conjunctival vessels White cornea Extreme pain

Question 30

What are some examples of acids that can cause damage?

Answer 30

Sulphuric acid (car batteries) Hydrochloric acid Vinegar Lemon

Question 31

Why is the prognosis better for acids than alkalis?

Answer 31

Acid is closer to neutral pH Alkali continues to penetrate

Question 32

What are some examples of solvents/abrasives/surfactants that cause damage?

Answer 32

Paint thinner Petrol Ethanol

Question 33

When is the prognosis worse for solvent/abrasive/surfactant damage?

Answer 33

If limbal stem cells destroyed

Question 34

What is the treatment for chemical injury?

Answer 34

Immediate rinse (irrigation) with saline for 20 mins or until pH neutral

Question 35

Why should the eye be irrigated nasally to temporal?

Answer 35

Avoids washing agent through punctum

Question 36

What can cause UV damage?

Answer 36

Welding Tanning beds Sailing Skiing

Question 37

What is damaged by UV? When does the damage appear?

Answer 37

Cornea Conjunctiva Both delayed damage which is very painful

Question 38

What is the treatment for UV damage?

Answer 38

Lubricants Cold compress Painkillers

Question 39

What can cause visible damage?

Answer 39

Lasers Sun Arc lights

Question 40

What is damaged by visible damage?

Answer 40

Photoreceptors permanently damaged - no treatment

Question 41

What can cause thermal damage?

Answer 41

Infrared light Conduction of heat

Question 42

What does IR damage cause?

Answer 42

Cortical cataract

Question 43

What damage does thermal conduction cause?

Answer 43

Superficial necrosis

Question 44

What are some examples of causes of thermal conduction damage?

Answer 44

Fireworks Sparks Boiling liquid

Question 45

What is the treatment for thermal damage?

Answer 45

Cold compress Painkillers Prophylactic antibiotics Cataract extraction