Ocular Trauma

Question 1

What is a teardrop sign?

Answer 1

Herniation of orbital fat (caused by blunt trauma)

Question 2

Which kind of fracture is common in children?

Answer 2

White eye blow out

Question 3

What can a teardrop sign compromise?

Answer 3

Inferior rectus

Question 4

When should a subconjunctival haemorrhage be worrying?

Answer 4

If you can no longer see through it (boggy haematoma)

Question 5

What causes traumatic uveitis?

Answer 5

Hit/punch in the eye

Question 6

Describe traumatic uveitis?

Answer 6

Inflammation of the front chamber of the eye

Breakdown of blood aqueous barrier

Question 7

What is hypaema?

Answer 7

Blood in the anterior chamber

Question 8

What causes a dislocated lens?

Answer 8

Zonules experience trauma will cause the lens to shift out of position and the patient will experience a change in vision

Question 9

What kind of tear is more common?

Answer 9

Retinal tear then choroidal tear

Question 10

What is commotio retinae?

Answer 10

Pale white sheen when retina is stunned

Can settle

If involves the macula and fovea it is worrying

Question 11

What is optic nerve avulsion

Answer 11

Complete shearing off of optic nerve

Question 12

What should be done if there is a suspected corneal laceration?

Answer 12

Look at pupil- brake in cornea will be plugged by iris

Sidels test

Question 13

What is sidles test?

Answer 13

Drop fluorescein onto surface of eye- will see dilution of dye though a lesceration

Question 14

How is a scleral laceration dealt with?

Answer 14

Surgery

If no regain in vision will have to take out eye

Question 15

What kind of injuries can small objects cause?

Answer 15

Sub-tarsal
Conjunctival
Corneal
Intra-ocular
Intra-orbital

Question 16

How is a corneal penetration with small object treated?

Answer 16

Give chloramphenicol 4x daily for a week, helps healing with no infection, ointment improves comfort

Question 17

What are causes for concern after corneal penetration?

Answer 17

Irregular pupil
Anterior chamber shallow
Localised Cataract
Gross inflammation

Question 18

If an intra-ocular foreign body is suspected what should be done?

Answer 18

X-ray

Question 19

Why are alkali burns so damaging?

Answer 19

Cicatrising- scarring changes to conjunctiva and cornea

Penetrates intra-ocular structures

Throws pH

Question 20

What should be looked for after a chemical burn to the eye?

Answer 20

Limbal ischaemia

Corneal vascularisation

Question 21

Describe limbal ischaemia?

Answer 21

China white
Irradiated any vascularity

Poor prognosis

Question 22

Describe Corneal vascularisation ?

Answer 22

Cornea should be clear- eye grows new vessels- only problematic if there cross the limbus

Question 23

Describe end stage scarring

Answer 23

Gross adhesion between eye and eyelids themselves

Question 24

Why are acid burns to the eye less damaging?

Answer 24

Coagulates proteins

Less penetrating

Question 25

Why should you be wary of lime/cement?

Answer 25

Very alkaline and particulate

Question 26

Describe the process of irrigation

Answer 26

REMOVE PARTICLES FIRST

Use local anaesthetic, minimum 2l of saline or until pH is normal

Question 27

What are the golden rules of ocular trauma?

Answer 27

1. History is key
2. Always record visual acuity
3. Don’t forger fluorescein
4. Handle suspected rupture with care
5. X-ray orbit if suspicious of IOFB
6. Immediate irrigation of chemical injuries