Ocular Trauma Flashcards
What must always be recorded in a patient with any eye pathology?
Visual acuity
How can an area of epithelial loss be identified?
Flurocein
What is a blow out fracture?
Pressure transmitted by hydraulic compression along the globe fractures the maxilla
How does a patient with a blow out fracture often present?
Inferior rectus damaged so patient cannot look up
Why must you be extra careful when examining children with a suspected ocular trauma?
White eye blowout - minimal symptoms but greenstick fracture can occur
What is often a sign of globe rupture?
Subconjunctival haemorrhage
Describe a subconjunctival haemorrhage
Bleeding from vessel under the conjunctiva often self limiting and asymptomatic
When does traumatic uveitis often present?
24-48 hours after blunt trauma with visible inflammatory cells in the eye
What is the name for blood in the anterior chamber?
Hyphaema
What can a retinal tear often be due to?
Vitreous detachment with abnormal adhesions or systemic disease
When can retinal detachment occur?
When vitreous liquefaction and retinal tear allow fluid to enter the sub retinal space
What is another name for a bruised retina?
Commotio Retinae
Describe a bruised retina
Grey-white opaqueness as a result of fragmentation of the photoreceptor outer segment and intracellular oedema
When is commotio retinae most serious?
If the macula/fovea are affected
What is optic nerve avulsion?
When the optic nerve disinherits from the retina, choroid and vitreous and separates from the globe
What form of investigation is usually required in penetrating trauma?
Imaging
Describe the appearance of a corneal laceration
Pupil border is misshapen and the iris may prolapse
What test can be done to detect a ‘leak’?
Siedel Test
What may happen as a result of a scleral laceration?
Contents of the eye may be expelled
What object is particularly hard to remove from someones eye?
Fish hook due to the barbs
After a penetrating injury what is the biggest risk?
Sympathetic Ophthalmia
Where can foreign bodies get stuck?
Sub-tarsal, conjunctival, cornea, intra-ocular, intra-orbital
What commonly gets stuck in the cornea?
Metal
How is a foreign body managed?
Remove using the beveled edge of a orange/green needle to shell out the foreign body with the patient under local anaesthetic. Chloramphenicol QDS for a week after.
What are the red flags related to a foreign body?
- irregular pupil
- shallow anterior chamber
- localised cataract
- gross inflammation
What foreign body is common intra-ocularly?
Fast moving particles (hammer and chisel)
If suspicion of intra-ocular foreign body what must be done?
X-ray
Describe an alkali burn
Rapid penetration, scars the conjunctiva and cornea as it penetrates through to the intra-ocular structures. Can cause ischaemia of the limbus
What is the key risk following alkali burn?
Limbus ischaemia - where the corneal stem cells are produced can lead to reduced healing
Describe an acid burn
Coagulates proteins to cause a cloudy opaque cornea
What factor makes the burn harder to heal?
Vascularisation
How are burns managed?
- Quick history and check toxobase
- Check pH
- Irrigate with minimum 2 litres saline until pH normal
- Assess with slit lamp
