Ocular Trauma Flashcards
what are the types of ocular trauma?
- Blunt trauma
- Penetrating trauma
- Chemical
what is part of the assessment of ocular trauma?
- Good history
- Visual acquits (triage + monitoring)
- Examination of the eye – lids, conjunctiva, cornea, anterior segment, pupils, fundus
- Use of fluorescein drops
what are fluorescein drops used for?
identifies epithelial loss – corneal abrasions
what are the golden rules of ocular trauma?
- History is key
- Always record visual acuity
- Don’t forget fluorescein
- Handle suspected rupture with care
- Xray orbit if suspicion of intraocular foreign body
- Immediate irrigation of chemical injuries (the solution to pollution is dilation)
what is the pathophysiology of blunt ocular trauma?
- Eye is a sphere so can take on trauma in different ways
* Can be deformed + reformed
what is the mechanism of a blow fracture?
o Force of blow is directed out amongst orbit
o Inferior + medial walls thinnest = break
what are the causes of blunt ocular trauma?
sport, assault, accidents
what are the clinical features of blunt ocular trauma?
o Eye prolapse - inferior rectus muscle catches
o Tear drop sign
Diplopia on upward gaze
what are the investigations of blunt ocular trauma?
- Xray of orbit + face
- CT scanning of orbits
- US of retina if unclear
what is a feature of ocular blunt trauma on xray?
black eyebrow sign
what are the common injuries of the cornea?
Corneal Rupture
Corneal Abrasion
what are the common injuries of the anterior chamber?
Hyphaemia
what are the common injuries of the iris?
Traumatic Uveitis
what are the common injuries of the lens?
Cataract
Phacodensis
Dislocation
what are the common injuries of the vitreous?
Haemorrhage
what are the common injuries of the retina?
Commotio retinae
Retinal detachment
Choroidal rupture
what are the common injuries of the optic nerve?
Traumatic neuropathy
Avulsion
what is the management of cornea injuries?
Suturing if unstable, if stable eye shield + follow up
Antibiotic eye ointment
what is the management of anterior chamber injuries?
Corticosteroid, dilate, monitor intraocular pressure
what is the management of iris injuries?
No treatment
what is the management of lens injuries?
Cataract extraction + artificial lens insertion
If unstable may require removal
what is the management of vitreous injuries?
Observe + monitor for signs of retinal rupture
what is the management of retina injuries?
No treatment but monitoring
Surgical input
If complete = operation, otherwise observation
what is the management of optic nerve injuries?
Intravenous corticosteroids
what is the pathophysiology of penetrating injuries of the eye?
• Injury that leads to open communication between the external environment and the inside of the eye
what are the causes of penetrating injuries of the eye?
- Hammerings (hammer + chisel)
- Glass
- Knife njuries
- Fishhooks
- Plants
what are the clinical features of penetrating injuries of the eye?
Lid, corneal and scleral laceration, Florence = Seidels Test, Iris plug
Sympathetic ophthalmia - autoimmune reaction
Small particles can be found in: Subtarsal (ice rink marks), Conjunctival, Corneal (rust ring), Intraocular – IOFB, Infraorbital
Irregular pupil, shallow anterior chamber, localised cataract
Gross inflammation
what is the management of penetrating ocular injuries?
- Rested, nil but mouth + shield placed over eye, tetanus given + pain medication
- If no foreign bodies or not accessible primary closure
- Intraocular foreign body may require vitreoretinal surgery
- Post operative high dose antibiotic + steroids drops are administered
what is the pathophysiology of alkali chemical ocular injuries?
o Rapid penetration, continues to burn o Liquefactive necrosis o Changes to conjunctiva + cornea o Rapid pH changes o Penetrates intra-ocular structures
what is the pathophysiology of acid chemical ocular injuries?
o Coagulate necrosis
o Little penetration
what are the causes of chemical ocular injuries?
Cleaning products, Industrial acid or alkalis, Cement or plaster, Battery acid, cosmetic
what are the clinical features of chemical injuries of the eye?
- Pain, redness, watering, reduced vision
- Alkali – new evidence of ischaemia
- Limbal ischaemia
- Corneal scarring
- Corneal vascularisation
what is the management of chemical ocular injuries?
- Assessment occurs after irrigation
- Quick history – nature of chemical, when, irrigation at event, beware of lime/cement
- Check toxbase if available
- Check pH (Litman paper)
- Irrigate (minimum of 2 saline, or until pH normal)
- Assess with at slit lamp
