Ocular Trauma Flashcards
What are the leading mechanisms of trauma to the eye?
Blunt trauma (41%) and penetrating injury without a foreign body (37%)
What is the most common age group affected by ocular trauma?
Age 25-34
How are males affected my ocular trauma?
Usually between the ages of 25-34, often related to assault or machinery
How are females affected by ocular trauma?
Usually aged >60, related to falling at home
What types of injuries are associated with poor outcomes?
Injuries that occur at home or in a public place and injuries caused by a fall or assault
What are the mechanisms by which ocular trauma can occur?
Blunt trauma, penetrating trauma (large/small), burns (chemical/physical)
What are the golden rules when assessing a patient with ocular trauma?
History is key, always record visual acuity, don’t forget fluorescein
What should areas be covered under your examination?
Lids, conjunctiva, cornea, anterior segment, pupils, fundus
What are fluorescein drops used for?
To identify areas of epithelial loss
What kind of fracture may occur due to blunt trauma?
Blowout fracture = fracture to one or more of the orbital walls but the orbital rim remains intact
What is the normal mechanism of injury of a blowout fracture?
Direct blow to central orbit, usually with a ball etc
What are some signs of a blowout fracture?
Tenderness and swelling around the eye, double vision (diplopia), nosebleeds
What part of the eye may be ruptured by blunt trauma?
The globe = must be handled with care
What are some features of traumatic uveitis that occurs following blunt trauma?
May be 2-3 days after initial insult before symptoms appear = eye pain, redness, blurred vision, tearing
What is hyphaema?
Blood in the anterior chamber = may be caused by blunt trauma
What are some injuries that may occur due to blunt trauma?
Tearing on intra-ocular structures, dislocated lens, retinal detachment, choroidal tear, optic nerve avulsion, severe intra-ocular disruption
What is commotio retinae?
Bruised retina = may be caused by blunt trauma
What may penetrating trauma by a large object cause?
Laceration, leak of fluid from eye, sympathetic ophthalmia
What are some areas of the eye that may be lacerated by a large object in penetrating trauma?
Lid, cornea, sclera
What are some features of penetrating trauma to the eye with fishhooks?
May involve all structures of the eye = associated with traumatic cataract, vitreous/choroidal haemorrhage and retinal detachment
What causes sympathetic ophthalmia?
Penetrating injury to one eye = causes exposure of intra-ocular antigens leading to auto-immune reaction in both eyes
What may sympathetic ophthalmia lead to?
Bilateral inflammation and eventual blindness
What are the different classes of small particles that may cause penetrating trauma to the eye?
Sub-tarsal, conjunctival, corneal, intra-ocular, intra-orbital
How are small particles removed from the eye?
Slit lamp used, local anaesthetic, edge of needle used to scrape/scoop, cover with chloramphenicol ointment after
What may be some features of penetrating trauma due to small particles?
Irregular pupil, shallow anterior chamber, localised cataract, gross inflammation
What should be done if there is suspicion of intra-ocular foreign bodies (IOFB)?
X-ray of the orbit
What do intra-ocular foreign bodies tend to be?
Fast moving particles (e.g from hammer/chisel injuries)
What are some features of alkali burns?
Easy and rapid penetration, cicatrising changes to conjunctiva and cornea, penetrates the intra-ocular structures
What are some features of acid burns?
Little penetration, coagulates proteins
What may chemical burns cause?
Ischaemia and scarring
What is the essential treatment for all chemical burns?
Immediate irrigation
What are the features of the assessment of a patient with chemical burns?
Occurs after thorough irrigation = history (nature of chemical, when etc), check toxobase and pH, irrigate until pH normal then assess at slit lamp
What chemicals should you be extra careful of?
Lime and cement
What is Siedel’s test used for?
Determining whether there is a corneal perforation
