Ocular Trauma

Question 1

Causes of Blunt Ocular Trauma

Answer 1

Sports injury, Motor vehicle accident, Fight, Domestic accident

Question 2

Pathogenesis of Blow-out Orbital Floor Fracture

Answer 2

Sudden increase in the orbital pressure by a striking object greater than 5cm in diameter

Question 3

Blow-out Orbital Floor Fracture Signs

Answer 3

• Periocular: Ecchymoses, oedema, subcutaneous emphysema
• Infraorbital nerve anaesthesia
• Diplopia

Question 4

Blow-out Orbital Floor Fracture Management

Answer 4

Refer to oculoplastic surgeon for computed tomography scan and repair of orbital floor

Question 5

Blow-out Medial Wall Fracture Signs

Answer 5

• Periorbital haematoma and frequently subcutaneous emphysema
• Defective abduction, if medial rectus is caught in the fracture

Question 6

Blow-out Medial Wall Fracture Management

Answer 6

Refer for further examination, treatment involves release of entrapped tissue and repair of bone defect

Question 7

Blunt Trauma Cornea signs

Answer 7

Corneal abrasion, acute corneal oedema, tears in descemet membrane

Question 8

Blunt Trauma Anterior Chamber signs

Answer 8

Hyphema

Question 9

Blunt Trauma Anterior Uvea Signs

Answer 9

Pupil: Vossius Ring, Mydriasys, radial pupillary tears
Iridodialysis: D-shaped pupil and dark bi-convex area near limbus
Ciliary body: Temporary cessation of aqueous secretion

Question 10

Blunt Trauma Lens signs

Answer 10

Cataract: rosette, Subluxation, Dislocation

Question 11

Blunt Trauma Globe signs

Answer 11

Globe rupture

Question 12

Blunt Trauma Retina and choroid signs

Answer 12

Commotio retinae, choroidal rupture, Retinal breaks and retinal detachment

Question 13

Blunt Trauma Optic nerve signs

Answer 13

Optic neuropathy, optic nerve avulsion

Question 14

Shaken baby syndrome presentation, systemic and ocular features

Answer 14

Physical abuse in children under 2 years of age, Irritability, lethargy, vomitting.
Systemic features: subdural haematoma and impact injuries to the head
Ocular features: Periorbital bruising, subconjunctival haemorrhages, poor visual response, afferent pupillary defect

Question 15

Definition of penetration

Answer 15

Single full-thickness wound, usually caused by a sharp object, without an exit wound

Question 16

Causes of penetrating trauma

Answer 16

assault, domestic accidents and sport

Question 17

Removal of superficial foreign bodies in tarsal conjunctival

Answer 17

Lid is everted and FB can be removed

Question 18

Removal of superficial foreign bodies in cornea

Answer 18

Removal with hypodermic needle after topical anaesthesia. Rust ring on bed of abrasion caused by ferrous foreign bodies must also be removed

Question 19

Mechanical effects of intraocular foreign bodies

Answer 19

cataract, vitreous liquefication, retinal haemorrhages and tears
• Iron undergoes siderosis that results in toxic effect and cell death
• High copper content can result in endophthalmitis, low copper content less toxic

Question 20

Sympathetic ophthalmitis pathogenesis

Answer 20

Sympathetic ophthalmitis is a bilateral granulomatous panuveitis occurring after penetrating trauma, often associated with uveal prolapse or intraocular surgery

Question 21

Sympathetic ophthalmitis signs

Answer 21

• Exciting eye: evidence of inital trauma and is red & irritable
• Sympathising: photophobic and irritable
• Both eyes: granulomatous anterior uveitis
• Multifocal mid-peripheral choroidal infiltrates

Question 22

Which chemical burns are more common and penetrate deeper

Answer 22

Alkali

Question 23

Chemical injury pathophysiology

Answer 23

• Necrosis of conjunctival and corneal epithelium
• Loss of limbal stem cell
• Deeper penetration cause stromal corneal opacification
• Anterior chamber penetration results in iris and lens damage
• Ciliary epithelium damages impair secretion of ascorbates which is required to corneal repair
• Hypotony and phthisis bulbi

Question 24

Emergency treatments

Answer 24

Without taking history

Copious irrigation, double-evesion of eyelids, debridement of necrotic epithelium