Ocular Trauma

Question 1

List the logical order to examine the eye for signs of ocular trauma

Answer 1

Lids
Conjunctiva
Cornea
Anterior segment
Pupils
Fundus

Question 2

How do fluorescein drops help with examining the eye?

Answer 2

Identify areas of epithelial loss - absorb light of one wavelength and emit light of another wavelength

Question 3

What is necessary to document when assessing ocular trauma?

Answer 3

Visual acuity

Question 4

How do orbital blowout fractures occur?

Answer 4

Direct blow to orbit causes increased intraorbital fracture, leading to fracture of orbital wall (usually inferior)

Question 5

List signs of an orbital blowout fracture

Answer 5

Severe swelling
Exophthalmus
Diplopia (damage to inferior rectus)
Numbness

Question 6

What is the main imaging done for orbital blowout fractures?

Answer 6

CT

Question 7

List potential causes of subconjunctival haemorrhage

Answer 7

Valsalva manoeuvre
Trauma
Contact lens
Hypertension
Bleeding disorders

Question 8

How does subconjunctival haemorrhage usually present?

Answer 8

Unilateral red eye with mild irritation

Examination usually normal

Question 9

What is a corneal abrasion?

Answer 9

Disruption in corneal epithelium

Question 10

List causes of corneal abrasion

Answer 10

Trauma (fingernail, brush, particle)
Contact lens irritation
Ocular foreign body
UV keratitis

Question 11

List symptoms + signs of corneal abrasion

Answer 11

Painful
Redness, injected vessels
Photophobia
Ice-rink cornea
Ulceration

Question 12

What is traumatic uveitis?

Answer 12

Inflammation of iris due to trauma which causes necrosis

Question 13

List early symptoms + signs of traumatic uveitis

Answer 13

Photophobia
Decreased visual acuity
Floaters
Intra-ocular tears
Diffuse redness

Question 14

What is hyphema?

Answer 14

Accumulation of red blood cells within anterior chamber of the eye, a sign of severe intra-ocular trauma

Question 15

Retinal detachment is an emergency. True/False?

Answer 15

True

Question 16

How does retinal detachment arise?

Answer 16

Subretinal fluid accumulates between the neurosensory retina and retinal pigment epithelium

Question 17

What are the signs and symptoms of retinal detachment?

Answer 17

Sudden flashes of light
Floaters
“heavy” eye
Shadow/veiled view

Question 18

In optic nerve avulsion, the eye is untreatable and blindness will definitely occur. True/False?

Answer 18

True :(

Question 19

Which connective tissue disease is associated with a dislocated lens?

Answer 19

Marfan’s syndrome (or any ligamentous laxity -associated CTD)

Question 20

What happens in sympathetic opththalmia?

Answer 20

Penetrating to one eye causes bilateral inflammation and potential blindness in both eyes

Question 21

How does corneal laceration usually arise?

Answer 21

Something sharp flying into/striking eye (fishhook, metal)

Question 22

Explain Siedel’s test for corneal laceration

Answer 22

Apply fluorescein dye; if it appears diluted then there is likely to be a leak (positive test)

Question 23

If you suspect an intra-ocular foreign body, what investigation is done?

Answer 23

XRAY

Water’s view

Question 24

Which type of chemical burn in the eye is worse - acid or alkali - and why?

Answer 24

Alkali
More penetrating
Scarring changes to conjunctiva + cornea

Question 25

Chemical burn is the only eye injury that needs treatment prior to history taking or examination. True/False?

Answer 25

True

Question 26

Outline management of chemical burn in the eye

Answer 26

Copious irrigation using saline
Monitor pH
Topical anaesthetic if required
THE SOLUTION TO POLLUTION IS DILUTION