Ocular Trauma

Question 1

What must always be recorded in a patient with any eye pathology?

Answer 1

Visual acuity

Question 2

How can an area of epithelial loss be identified?

Answer 2

Flurocein

Question 3

What is a blow out fracture?

Answer 3

Pressure transmitted by hydraulic compression along the globe fractures the maxilla

Question 4

How does a patient with a blow out fracture often present?

Answer 4

Inferior rectus damaged so patient cannot look up

Question 5

Why must you be extra careful when examining children with a suspected ocular trauma?

Answer 5

White eye blowout - minimal symptoms but greenstick fracture can occur

Question 6

What is often a sign of globe rupture?

Answer 6

Subconjunctival haemorrhage

Question 7

Describe a subconjunctival haemorrhage

Answer 7

Bleeding from vessel under the conjunctiva often self limiting and asymptomatic

Question 8

When does traumatic uveitis often present?

Answer 8

24-48 hours after blunt trauma with visible inflammatory cells in the eye

Question 9

What is the name for blood in the anterior chamber?

Answer 9

Hyphaema

Question 10

What can a retinal tear often be due to?

Answer 10

Vitreous detachment with abnormal adhesions or systemic disease

Question 11

When can retinal detachment occur?

Answer 11

When vitreous liquefaction and retinal tear allow fluid to enter the sub retinal space

Question 12

What is another name for a bruised retina?

Answer 12

Commotio Retinae

Question 13

Describe a bruised retina

Answer 13

Grey-white opaqueness as a result of fragmentation of the photoreceptor outer segment and intracellular oedema

Question 14

When is commotio retinae most serious?

Answer 14

If the macula/fovea are affected

Question 15

What is optic nerve avulsion?

Answer 15

When the optic nerve disinherits from the retina, choroid and vitreous and separates from the globe

Question 16

What form of investigation is usually required in penetrating trauma?

Answer 16

Imaging

Question 17

Describe the appearance of a corneal laceration

Answer 17

Pupil border is misshapen and the iris may prolapse

Question 18

What test can be done to detect a ‘leak’?

Answer 18

Siedel Test

Question 19

What may happen as a result of a scleral laceration?

Answer 19

Contents of the eye may be expelled

Question 20

What object is particularly hard to remove from someones eye?

Answer 20

Fish hook due to the barbs

Question 21

After a penetrating injury what is the biggest risk?

Answer 21

Sympathetic Ophthalmia

Question 22

Where can foreign bodies get stuck?

Answer 22

Sub-tarsal, conjunctival, cornea, intra-ocular, intra-orbital

Question 23

What commonly gets stuck in the cornea?

Answer 23

Metal

Question 24

How is a foreign body managed?

Answer 24

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.

Question 25

What are the red flags related to a foreign body?

Answer 25

• irregular pupil
• shallow anterior chamber
• localised cataract
• gross inflammation

Question 26

What foreign body is common intra-ocularly?

Answer 26

Fast moving particles (hammer and chisel)

Question 27

If suspicion of intra-ocular foreign body what must be done?

Answer 27

X-ray

Question 28

Describe an alkali burn

Answer 28

Rapid penetration, scars the conjunctiva and cornea as it penetrates through to the intra-ocular structures. Can cause ischaemia of the limbus

Question 29

What is the key risk following alkali burn?

Answer 29

Limbus ischaemia - where the corneal stem cells are produced can lead to reduced healing

Question 30

Describe an acid burn

Answer 30

Coagulates proteins to cause a cloudy opaque cornea

Question 31

What factor makes the burn harder to heal?

Answer 31

Vascularisation

Question 32

How are burns managed?

Answer 32

1. Quick history and check toxobase
2. Check pH
3. Irrigate with minimum 2 litres saline until pH normal
4. Assess with slit lamp