Ocular trauma

Question 1

What team?!

Answer 1

WILDCATS!!

Question 2

initial assessment of ocular trauma (4)

Answer 2

good hx of incident
visual acuity
examine eye- lids, conjunctiva, cornea, pupils, funds, ant chamber
fluorescein to check for epithelial loss

Question 3

6 golden rules of ocular trauma

Answer 3

Hx key
always read visual acuity
Fluorescein
handle suspect globe rupture with care
X ray orbit if suspect intra-oular foreign body 
immediate irrigation of chemical injury

Question 4

blow out fracture

• occurs where
• can result in what (3)

Answer 4

-fracture of the inferior wall of the orbit

-herniation of the orbital contents
tethering go the IR muscle to the floor of the orbit
sub-conjuntival haemorrhage

Question 5

Traumatic uveitis

• what is it
• signs (2)

Answer 5

• inflammation of the middle layers of the eye due to trauma and leakage of proteins into the ant chamber
• photophobia and slight pupillary constriction

Question 6

Hyphaema

• what is it
• presentation
• management

Answer 6

• RBC in the ant chamber can cause increased intraocular pressure as it might clog the trabecullar network
• reduced vision, RBC obscure the back of the eye
• tend to resolve, if not then theatre

Question 7

Give the findings on examination of the following structures should they tear:

• iris
• lense
• retinal detachment
• choroidal tear
• optic nerve avulsion

Answer 7

• can disinherit from the point of attachment, see a misshapen pupil
• dislocated lens, see zonular fibres
• vessels twisted and tortuous, see folds in the retina
• retina intact but vial deficit
• haemorrhage around the optic disc

Question 8

corneal laceration

• caused by
• signs (2)

Answer 8

-fast moving particles

-fluorescein will be diluted around the point of entry as there is a leak of aqueous humour
disordered tear shaped pupil with a flat ant chamber

Question 9

name the 5 types of injury caused by small penetrating particles

• presentation
• management

Answer 9

-subtarsal
uncomfortable and worse on blinking
evert the upper eyelid and lift off with a cotton wool bud
fluorescein used might see ice rink cornea

-conjunctival
easily seen and removed with slit lamp

-corneal
commonly metal particles, slow onset
remove and give chloramphenicol

(penetrating foreign body presents as:
irregular pupil, shallow ant chamber, localised cataract and gross inflammation, do US to establish depth)

-intra lenticular
inside lens so cataract likely

-intra ocular
fast moving particles
do X-ray with one eye looking up and see if FB changes position

Question 10

Chemical burns

• appearance of acid (2) and alkali burns (5)
• management
• hx features

Answer 10

-Acid
coagulates protein, inflammation and scarring on the cornea

Alkali
surface ischaemia 
china white sign (reduced vessels at limbus)
corneal scarring and visual deficit
corneal vascularisation
end stage scarring and visual loss

• IRRIGATION!! with saline
• nature of the chemical, when the burn occurred and hx of irrigation