Ocular trauma Flashcards
What is the structure of the assessment of ocular trauma (6)?
- Thorough history
- Mechanism of trauma
- Visual acuity
- Dilated fundoscopy
- Appropriate systemic examination
- Investigation/imaging
What are some important qs to ask in the history of someone with ocular trauma (7)?
- How and when did the injury occur?
- Any non-ocular injury?
- First-aid treatment given?
- Past ocular history?
- PMH?
- Drugs/allergies?
- When was tetanus administered in the past?
What examinations do you need to do for ocular trauma (8)?
- Overall assessment and general medical examination - life threatening conditions take priority i.e. A-E
- Visual acuity with/out pinhole
- Assessment of each ocular structure
- Pupil examination
- Eye position (proptosis)
- Eye movements
- Visual fields
- Sensation (parasthesia of corneal, maxilla)
When examining the eye for ocular trauma, what are the ocular structures you need to examine (12)?
- Orbit
- Eyelids
- Lacrimal apparatus
- Conjunctiva
- Cornea
- Anterior chamber
- Iris
- Lens
- Vitreous
- Retina
- Optic nerve
- Intraocular pressure
What investigations are done for 3 different types of ocular trauma?
- Chemical injury - pH
- Orbital injury - orthoptic assessment, CT scan
- Penetrating eye injury - X-ray for intraocular foreign body, CT, US
What are 4 different forms of ocular trauma?
- Perforating - breach in ocular coats
- Non-perforating - contusional/blunt injury
- Corneal foreign body
- Chemical injury
What is commonly the history of PC for a corneal foreign body (4)?
- Grinding injury
- Sudden onset irritation
- Gritty, watering eye
- Photophobia (FB scratches cornea)
What 3 things may be seen on examination for a corneal FB?
- Metallic FB on cornea
- +/- rust ring
- Anterior uveitis
What do you need to be aware of when the eye trauma occurs as a result of hammering metal?
How would you investigate it?
High velocity so there may be an intraocular foreign body, penetrating injury
X-ray
What is the urgent first aid of chemical ocular injuries?
Washout with 2L water/saline immediately, continue to irrigate and check pH of both eyes
What are the 2 reasons you need to check the pH of the eyes with chemical ocular injury?
- Check if pH is acidic or alkaline
2. To compare injured eye with normal eye
Why do you need to know if pH is acidic or alkaline in chemical ocular injury? Which is worse?
Alkaline is worse - it can penetrate to the anterior chamber and can lead to more damage
Acids coagulate proteins and have generally less penetration
What questions in the history should you ask when presented with a blunt ocular injury (8)?
- Visual disturbance or LOV
- Pain
- Tenderness at rest or on movement
- Diplopia
- Rule out presence of penetrating injury
- Use of eye protection
- Hx of previous trauma or surgery - can influence the outcome of the traumatic event
- Associated injuries
What 5 ocular examinations do you need to do with blunt injury?
- Visual acuity
- Visual fields
- Intraocular pressure assessment
- Fundus examination
- Red reflex
What 4 extraocular examinations do you need to do with blunt injury?
- Lid trauma, periorbital bruising and facial fractures
- Slit lamp examination for anterior segment examination of cornea, conjunctiva, sclera, anterior chamber for presence of hyphaema
- Pupil examination for RAPD, traumatic mydriasis
- Extraocular movements
In blunt injury, what 2 things could absence of red reflex indicate?
- Vitreous haemorrhage
2. Retinal detachment
What 3 things could restriction of ocular movements in blunt trauma indicate?
- Fracture of orbital floor or wall
- Retrobulbar haematoma
- Cranial nerve palsies
What imaging can be done for blunt eye injuries and what would they be checking for (2)?
- Ocular US
- X-ray or CT scan of orbits - check for blow-out fractures of orbital floor or other orbital walls. Also to rule out head injuries
How are superficial ocular injuries and associated eye lacerations managed (2)?
- Topical Abx and analgesics
2. Eyelid lacerations may require suturing
What 7 ocular injuries require urgent referral to the ophthalmologist?
- Ocular chemical burns
- Perforation of cornea or rupture globe
- Traumatic hyphaema
- Lens subluxation or dislocation
- Laceration of lid margins and/or nasolacrima duct system
- Traumatic optic neuropathy
- Retrobulbar haemorrhage with raised intraocular pressure
What are some important effects of blunt injury on the eye (5)?
- Hyphaema
- Lens dislocation or cataract
- Vitreous haemorrhage
- Retinal tears/detachment
- Retinal oedema and haemorrhage
What is an important consequence of a hyphaema?
Associated with raised intraocular pressure - acute glaucoma
What are the the different types of perforating eye injuries (2)?
- Lid lacerations
- full thickness lid lacerations
- involving the lacrima canalicular system - Corneal lacerations
- due to intraocular foreign body
- from previous ocular surgery with wound dehiscence
