Ocular Trauma Flashcards
What are the main causes of ocular trauma?
Work related (often minor)
Assault
Accidents around the home
Sports associated eye injury
Describe the main mechanisms of injury to the eye?
Blunt trauma
Penetrating trauma
Burns
How do we identify the area of epithelial loss in ocular trauma?
Fluorescein drops (orange dye viewed with blue light on slit lamp => turns lesions green)
What are the golden rules when dealing with ocular trauma?
- History is key
- Always record visual acuity
- Don’t forget Fluorescein
- Handle a suspected globe rupture with care
- Always X-Ray for intra-ocular foreign body
- Immediate irrigation for chemical injuries
What structure is most likely to be damaged in blunt trauma?
Inferior wall of the orbit due to dissipating force
=> this path has the least resistance and leads to blowout fracture
What sign can be seen on CT as evidence of a blowout fracture?
Teardrop sign
Contents of eye look to be escaping out inferior wall of orbit
What eye movement is often compromised on a blowout fracture?
Looking up
Inferior rectus becomes tethered to fat in the fracture and cant move to allow eye to move upwards
What is special about the appearance of children’s eyes when they develop a blowout fracture?
White eye blowout fracture (rest of eye appears very normal)
When a haematoma is present in the eye the sclera can still be seen. TRUE/FALSE?
FALSE
What is a hyphaema?
Blood in the anterior chamber of the eye
RBCs float down and lie at bottom due to gravity
What causes the inflammation in the anterior chamber of the eye in traumatic uveitis?
Breakdown of the blood-ocular barrier causes the inflammation
usually a result of a punch/ball injury
When the iris tears away from the ciliary body, what can this cause?
Blockage at the drainage angle
The lens has the potential to dislocate, even if it is artificial. TRUE/FALSE?
TRUE
Describe the mechanism of retinal detachment
- 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
What is meant by Commotio Retinae?
Bruised retina
The anterior chamber can still be visualised easily even if there is a severe intra-ocular disruption. TRUE/FALSE?
FALSE
it is difficult to see any of the anterior chamber in a severe intra-ocular disruption
What other structures can be involved when large objects cause penetrating trauma to the eye?
Brain
Blood vessels
Orbit
When is lid laceration most commonly seen?
In animal attacks of children
How can a corneal laceration be identified?
Pupil appears not circular
Iris prolapses out to plug the wound
What test is used to visualise a corneal leak?
Siedel’s Test:
Full thickness penetration of cornea allows aqueous humour to leak out
=> fluorescein dye used to visualise the leak
How is scleral laceration primarily treated?
General Anaesthetic in theatre
Primary Repair
If vision does not improve = eye replacement
What is important to remember about fish hook injuries to the eye?
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
What is sympathetic ophthalmica
- 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)
Where is it possible for small foreign bodies to sit in the eye?
Sub-tarsal (under upper eyelid) Conjunctival Corneal Intra-ocular Intra-orbital
What symptoms would make you worry more about a penetrating foreign body?
- Pupil irregular
- Anterior Chamber shallow
- Localised cataract
- Gross inflammation
Intra-ocular foreign bodies should always have an X-Ray. TRUE/FALSE?
TRUE
What is the difference between an alkali and acidic burn to the eye?
Alkali
- rapid penetration (into intra-ocular structures)
- scarring on conjunctiva and cornea
- evidence of limbal ischaemia
Acid
- coagulates proteins
- little penetration
- NOT AS BAD
What is limbal ischaemia?
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
What can end stage scarring from a burn cause?
Adhesions between the eyelid and eyeball
Why should we beware of patients working with cement?
It contains LIME (very alkali)
=> must be careful not to get any foreign bodies in their eye
How can we test the pH of a patients eye?
place pH paper in tear film and either:
- compare to other eye if suspected neutral
- compare to your own eye assuming it is neutral
How can ocular trauma be prevented in the workplace, during sports or even at home?
Ensure safe practices - training, up-to-date machinery
Protective eye wear
Clear rules - sport and work
Education - to ensure awareness
