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OPHTHALMOLOGY > Ocular Trauma > Flashcards

Ocular Trauma Flashcards

1
Q

What are the main causes of ocular trauma?

A

Work related (often minor)
Assault
Accidents around the home
Sports associated eye injury

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2
Q

Describe the main mechanisms of injury to the eye?

A

Blunt trauma
Penetrating trauma
Burns

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3
Q

How do we identify the area of epithelial loss in ocular trauma?

A

Fluorescein drops (orange dye viewed with blue light on slit lamp => turns lesions green)

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4
Q

What are the golden rules when dealing with ocular trauma?

A
  1. History is key
  2. Always record visual acuity
  3. Don’t forget Fluorescein
  4. Handle a suspected globe rupture with care
  5. Always X-Ray for intra-ocular foreign body
  6. Immediate irrigation for chemical injuries
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5
Q

What structure is most likely to be damaged in blunt trauma?

A

Inferior wall of the orbit due to dissipating force

=> this path has the least resistance and leads to blowout fracture

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6
Q

What sign can be seen on CT as evidence of a blowout fracture?

A

Teardrop sign

Contents of eye look to be escaping out inferior wall of orbit

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7
Q

What eye movement is often compromised on a blowout fracture?

A

Looking up

Inferior rectus becomes tethered to fat in the fracture and cant move to allow eye to move upwards

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8
Q

What is special about the appearance of children’s eyes when they develop a blowout fracture?

A

White eye blowout fracture (rest of eye appears very normal)

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9
Q

When a haematoma is present in the eye the sclera can still be seen. TRUE/FALSE?

A

FALSE

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10
Q

What is a hyphaema?

A

Blood in the anterior chamber of the eye

RBCs float down and lie at bottom due to gravity

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11
Q

What causes the inflammation in the anterior chamber of the eye in traumatic uveitis?

A

Breakdown of the blood-ocular barrier causes the inflammation

usually a result of a punch/ball injury

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12
Q

When the iris tears away from the ciliary body, what can this cause?

A

Blockage at the drainage angle

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13
Q

The lens has the potential to dislocate, even if it is artificial. TRUE/FALSE?

A

TRUE

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14
Q

Describe the mechanism of retinal detachment

A
  • Vitreous gel detaches from the back wall and tugs retina with it
  • Retina tears allowing fluid behind it
  • This fluid pushes the retina off the wall
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15
Q

What is meant by Commotio Retinae?

A

Bruised retina

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16
Q

The anterior chamber can still be visualised easily even if there is a severe intra-ocular disruption. TRUE/FALSE?

A

FALSE

it is difficult to see any of the anterior chamber in a severe intra-ocular disruption

17
Q

What other structures can be involved when large objects cause penetrating trauma to the eye?

A

Brain
Blood vessels
Orbit

18
Q

When is lid laceration most commonly seen?

A

In animal attacks of children

19
Q

How can a corneal laceration be identified?

A

Pupil appears not circular

Iris prolapses out to plug the wound

20
Q

What test is used to visualise a corneal leak?

A

Siedel’s Test:
Full thickness penetration of cornea allows aqueous humour to leak out
=> fluorescein dye used to visualise the leak

21
Q

How is scleral laceration primarily treated?

A

General Anaesthetic in theatre
Primary Repair
If vision does not improve = eye replacement

22
Q

What is important to remember about fish hook injuries to the eye?

A

You cannot pull the fish hook out straight away as this will do more damage
Second wound needs to be created to remove it with less damage

23
Q

What is sympathetic ophthalmica

A
  • Penetrating injury to one eye
  • exposure of intra-ocular antigens
  • auto-immune reaction and inflammation in BOTH eyes
  • May = bilateral blindness (from a unilateral injury)
24
Q

Where is it possible for small foreign bodies to sit in the eye?

A 
Sub-tarsal (under upper eyelid)
Conjunctival
Corneal
Intra-ocular
Intra-orbital
25
Q

What symptoms would make you worry more about a penetrating foreign body?

A
  • Pupil irregular
  • Anterior Chamber shallow
  • Localised cataract
  • Gross inflammation
26
Q

Intra-ocular foreign bodies should always have an X-Ray. TRUE/FALSE?

A

TRUE

27
Q

What is the difference between an alkali and acidic burn to the eye?

A

Alkali

  • rapid penetration (into intra-ocular structures)
  • scarring on conjunctiva and cornea
  • evidence of limbal ischaemia

Acid

  • coagulates proteins
  • little penetration
  • NOT AS BAD
28
Q

What is limbal ischaemia?

A

Limbus = corneal/conjunctival junction
=> full of limbal stem cells which regenerate the cornea

If damaged the cornea cant regenerate => china white appearance of limbal ischaemia

29
Q

What can end stage scarring from a burn cause?

A

Adhesions between the eyelid and eyeball

30
Q

Why should we beware of patients working with cement?

A

It contains LIME (very alkali)

=> must be careful not to get any foreign bodies in their eye

31
Q

How can we test the pH of a patients eye?

A

place pH paper in tear film and either:

  • compare to other eye if suspected neutral
  • compare to your own eye assuming it is neutral
32
Q

How can ocular trauma be prevented in the workplace, during sports or even at home?

A

Ensure safe practices - training, up-to-date machinery
Protective eye wear
Clear rules - sport and work
Education - to ensure awareness

OPHTHALMOLOGY (12 decks)

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