Ocular Trauma Flashcards
what are the six golden rules of eye trauma?
- history is key
- always record visual acuity
- don’t forget fluorescein
- handle suspected globe rupture with care
- XR orbits if suspicious of intra-ocular foreign body
- immediate irrigation of chemical injuries (solution to pollution is dilution)
diagnosis of blow out fracture
tear drop or blood level in sinus on imaging
white eye blow-out fracture in kids
what is a subconjunctival haemorrhage?
small blood vessels within the conjunctiva rupture
causes of subconjunctival haemorrhage?
can be spontaneous
traumatic (coughing)
indicator of hypertension or bleeding diathesis (check meds)
presenation of subconjunctival haemorrhage
bright red blood in front of sclera
painless
no change in vision
management of subconjunctival haemorrhage
resorbs 10-14 days
what is a corneal abrasion?
removal of epithelium
causes of corneal abrasion
contact lenses
foreign body
fingernails
presentation of corneal abrasion
severe pain (exposure of nerve endings) lacrimation sensitivity to light miserable blepharospasm (unable to open their eye)
diagnosis of corneal abrasion
orange fluorescein drops
abrasion shows green in blue slit light examination
management of corneal abrasion
topical anaesthetics (oxybuprocaine or tetracaine) chloramphenicol
presentation of corneal laceration
pupil may be misshapen if cornea involved
what is seidel test used for?
assess anterior chamber leakage
risks in a foreign body under the upper eyelid?
sub-tarsal scarring
damage conjunctiva
presentation of foreign body
gritty eye
lacrimation
photophobia
management of foreign body
topical LA and examine
once removed give chloramphenicol or fusidic acid
what to consider with foreign bodies?
Welder’s arc eye
chemicals!
what is traumatic uveitis?
inflammation of the uvea layer
presentation of traumatic uveitis
24-48 hours later with photophobia
what is a commotio retinae?
bruised retina
if affecting macula/fovea can have lasting impact on sight
causes of commotio retinae
blunt trauma
presentation of commotio retinae
lid oedema
opaque milky appearance in back of eye
what is a synechia?
iris adheres to either the cornea or lens
what conditions is a synechia common in?
iritis iridocyclitis (or glaucoma)
what is sympathetic ophthalmia
penetrating injury to one eye causes exposure of intra-ocular antigens leading to AI reaction in both eyes
can lead to bilateral blindness
two types of burns
- alkaline
2. acid
what does an alkaline burn do to the eye?
rapid penetration due to liquefactive necrosis
cicatrising change conjunctiva and cornea
penetration of intra-ocular structures
ischaemia around limbus
china white eye
what does an acid burn do to the eye?
coagulates protein
coagulative necrosis
why is it difficult for the cornea to heal?
avascular
management of burns
history= chemical (toxbase), when, beware of lime/cement
check pH and irrigate (minimum of 2L of saline until pH normalises)
assess at slit lamp
causes of mydriasis (dilated pupil)
CNIII palsy Holmes-Adie syndrome raised ICP congenital trauma stimulants (cocaine) anticholinergics
causes of miosis (constricted)
Horner's syndrome cluster headaches Argyll-Robertson pupil (neurosyphilis) opiates nicotine pilocarpine
