Ocular Trauma

Question 1

Potential causes of ocular trauma?

Answer 1

• Work-related (often minor)
• Assault
• Accidents at home
• Sports-assoc. eye injury
• Other causes

Question 2

3 mechanisms of injury to the eyes?

Answer 2

Blunt trauma

Penetrating trauma (small or large objects)

Burns (chemical or physical)

Question 3

Assessment of ocular trauma?

Answer 3

Hx of the incident

ALWAYS ASSESS AND NOTE VISUAL ACUITIES

Examination of the eye (all layers)

Question 4

During examination of the eye, how can areas of epithelial loss be identified?

Answer 4

Using FLUORESCEIN drops, e.g: for a corneal abrasion, ulcer, scratch, etc

Shining a blue light on to the eye after using eye drops causes it to glow BRIGHT GREEN in areas of epithelial loss

Question 5

Treatment of a corneal abrasion?

Answer 5

Chloramphenicol QDS for 1 week; if may be given for longer, if necessary

This prevents infections and soothes the eye whilst healing occurs

Question 6

What is an orbital blowout fracture?

Answer 6

Traumatic fracture to the orbital floor or medial wall, typically resulting from impact of a blunt object, larger than the orbital aperture (e.g: a tennis ball)

Question 7

Symptoms and signs of an orbital blowout fracture?

Answer 7

Inability to look up (inferior rectus is trapped in the fracture site)

Question 8

Ix for orbital blowout fractures?

Answer 8

CT scan shows a “tear drop” sign

Question 9

Cause of deforming injuries to the eye?

Answer 9

Typically caused by globe rupture, which may occur due to:
• Blunt trauma from an object that is smaller than the orbital aperture (e.g: a squash ball)
• Penetrating injury

Question 10

What is a globe rupture?

Answer 10

Ophthalmologic emergency that can lead to blindness

Integrity of the outer membranes of the eye is disrupted by blunt or penetrating trauma

Question 11

Signs and symptoms of a globe rupture?

Answer 11

Obvious deformation of the eye

Question 12

Ix for a globe rupture?

Answer 12

Handle with care

Question 13

What is traumatic uveitis?

Answer 13

Sub-type of anterior uveitis that is typically caused by blunt trauma

May result with the leakage of proteins and WBCs into the anterior chamber

Question 14

Signs and symptoms of traumatic uveitis?

Answer 14

Painful red eye that is tearing

Photophobia

Blurred vision

May have a hypopyon

Question 15

What is a hyphaema?

Answer 15

Blood in the anterior chamber

Question 16

What is a dislocated lens?

Answer 16

Blunt trauma to the eye can cause damage to the zonule fibers (attach lens to the ciliary body), resulting in dislocation of the lens

Question 17

Signs and symptoms of a dislocated lens?

Answer 17

Patient has blurry vision or monocular diplopia

Question 18

What is a retinal detachment?

Answer 18

Retina peels away, e.g: due to trauma (vitreous fluid can leak behind the retina and peel it off)

Question 19

What is a choroidal tear?

Answer 19

A break in the choroid, Bruch membrane, and the retinal pigment epithelium (RPE) that results following a closed globe injury from blunt trauma

Question 20

What is a Commotio Retinae?

Answer 20

AKA ‘bruised retina’

Degeneration of the layers of the retina secondary to shock waves caused by blunt trauma/blast injury

Question 21

Signs and symptoms of Commotio retinae?

Answer 21

Pale and water-logged (oedematous) retina

Question 22

What is optic nerve avulsion?

Answer 22

May occur due to trauma

Question 23

Describe lid laceration?

Answer 23

May spare the eyeball itself; can be caused by dog bites

Question 24

How can fluorescein be used to differentiate between an abrasion and a penetrating injury?

Answer 24

Seidel’s test - assess the presence of anterior chamber leakage in the cornea

Fluorescein can display a leak (Seidel’s +ve, which indicates a penetrating injury)

Question 25

Other types of penetrating eye injuries (from large objects)?

Answer 25

Corneal laceration

Scleral laceration

Fish-hook injury

Question 26

What is sympathetic ophthalmia?

Answer 26

Rare cause of bilateral blindness (from a unilateral injury)

Penetrating injury to one eye exposes the intra-ocular antigens; there is an auto-immune reaction in both eyes and inflammation

Question 27

Areas that small particles (foreign bodies) can cause damage to in the eyes?

Answer 27

• Sub-tarsal
• Conjunctival
• Corneal
• Intra-ocular
• Intra-orbital

Question 28

When would suspicion arise of a penetrating foreign body?

Answer 28

If the:
• Pupil was irregular
• Anterior chamber was shallow
• Localised cataract
• Gross inflammation

Question 29

Ix for potential intra-ocular foreign bodies (IOFBs)?

Answer 29

Always X-RAY; these can be taken with different eye positions, e.g: looking up and then down, to see if the particle is capable of movement

Question 30

Causes of chemical burns?

Answer 30

Alkali - easily and rapidly penetrate to cause:
• Cicatrising changes to the conjunctiva and cornea
• Penetrates the intra-ocular structures

Acid - coagulates proteins but has little penetrative potential

Burn can lead to corneal scarring and vascularisation; the end-stage of scarring is potentially devastating

Question 31

Signs of an alkali burn?

Answer 31

Limbal ischaemia and a totally avascular cornea (china-white cornea), which is abnormal

Question 32

Important Hx points with a chemical injury to the eye?

Answer 32

Nature of the chemical

When it occurred

Irrigation at the event

LIME/CEMENT (beware)

Question 33

Mx of a chemical injury to the eye?

Answer 33

Check Toxbase if available (contains information and guidelines about different chemicals)

Check pH (with universal indicator paper; normal tear film is slightly alkaline)

IMMEDIATE IRRIGATION (with a minimum of 2 litres of saline OR until the pH is normal)

Then assess at slit lamp (after irrigation)