Ocular Trauma Flashcards
What are the important questions to ask in a history of ocular trauma?
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 should be included in the examination of a patient with ocular trauma?
Overall assessment and general medical examination - life threatening conditions
VISUAL ACUITY with or without pin hole
Assess each ocular structure in a tailored manner - orbit, eyelids, lacrimal apparatus, conjunctiva, cornea, anterior chamber, iris, lens, vitreous, retina, optic nerve, intraocular pressure
Pupil exam and eye positions, eye movements and visual fields, sensation
What should be included in an ocular trauma assessment?
thorough history mechanism of trauma visual acuity ophthalmoscopy appropriate systemic examination investigation/imaging
How should a chemical injury be managed?
Serious - needs immediate treatment
immediate irrigation with saline (several litres) determine if acidic or alkaline (alkaline is more severe)
check pH of both eyes for comparison
antibiotics, vit C, steroid, mydriatic
List examples of ocular trauma
blunt trauma peri-orbital haematoma hyphaema (blood in anterior chamber) traumatic cataract subluxation of lens due to rupture of lens zonules retinal tears retinal detachment severe retinal haemorrhage associated with blunt trauma blowout fracture restriction of eye movements periorbital swelling may be associated with ocular damage penetrating eye injury intraocular foreign body
What are the important investigations to carry out in ocular trauma?
Chemical injury - pH
Orbital injury - orthoptic assessment, CT scan, x-ray
Penetrating eye injury - x-ray for foreign body, CT, USS
What does the absence of a red reflex suggest?
vitreous haemorrhage, retinal detachment
What would restricted eye movements indicate?
fracture of the orbital floor or wall
retrobulbar haematoma
cranial nerve palsies
What are two different types of ocular injury?
Perforating - breach in ocular coats
Non perforating - contusional, blunt injury
How are superficial injuries generally managed?
topical antibiotics & analgesics
Which ocular injuries require urgent referral to an ophthalmologist?
Ocular chemical burns
Perforation of cornea or rupture globe
Traumatic hyphaema
Lens subluxation or dislocation
Laceration of lid margins and/or nasolacrimal duct system
Traumatic optic neuropathy
Retrobulbar haemorrhage with raised intraocular pressure
What are the important possible consequences of a blunt injury on the eye?
Corneal abrasion Blood in anterior chamber - hyphaema Traumatic mydriasis Iridodialysis Traumatic iritis Iridocorneal angle recession diagnosed with gonioscopy Lens dislocation or cataract Vitreous haemorrhage Retinal oedema and haemorrhage Retinal detachment Blow-out fracture Management of blunt injuries to the eye ball Superficial corneal abrasions Lamellar superficial lacerations of cornea Fluorescein eye drops to detect leakage of aqueous Traumatic cataracts
