Ocular Trauma

Question 1

What are the main mechanisms for ocular trauma?

Answer 1

Blunt trauma

Penetrating injury

Question 2

What tool is needed when examining ocular trauma?

Answer 2

Fluorescein drops

Question 3

What are the most common blowout fractures?

Answer 3

Medial (inferior can also happen)

Question 4

What does a sub-conjunctival haemorrhage look like?

Answer 4

Light red appearance on the surface of the eye

Question 5

What mechanisms commonly cause a sub-conjunctival haemorrhage?

Answer 5

Punch to the eye

Patient itching or rubbing eye

Question 6

How serious are sub-conjunctival haemorrhages?

Answer 6

Not vey - generally resolve like a bruise

Question 7

When might you suspect a globe rupture?

Answer 7

Cant see underlying sclera because of redness
Dark, boggy sub-conjunctival blob
Poor vision
Bad pressure
Soft

Question 8

What should be done if you suspect globe rupture?

Answer 8

Treat with caution - don’t put pressure on it
USS
Examination under anaesthetic
CT

Question 9

How can trauma cause uveitis?

Answer 9

Trauma can cause breakdown of the blood-aqueous barrier

Question 10

How does uveitis present?

Answer 10

Cells floating around anterior chamber
Flare - murky grey appearance
Pupil stuck down on lens - can’t dilate

Question 11

What is hyphaema?

Answer 11

Blood in the anterior chamber

Question 12

How does trauma cause retinal detachment?

Answer 12

Trauma disrupts the vitreous gel attached tot eh back wall of the retina which tugs a hole/tear in the retina
Vitreous fluid gets in behind the retina and gradually peels it off

Question 13

What is Siedel’s test?

Answer 13

A test to assess the presence of anterior chamber leakage with fluorescein dye

Question 14

What is sympathetic ophthalmia?

Answer 14

Where a penetrating injury to one eye results in exposure of intra-ocular antigens and leads to an autoimmune reaction in both eyes

Question 15

Where can small foreign bodies be lodged?

Answer 15

Sub-tarsal (under upper eyelid)
Conjunctival
Corneal
Intra-ocular
Intra-orbital

Question 16

What is the most common location for a foreign body?

Answer 16

Cornea

Question 17

How are corneal foreign bodies removed?

Answer 17

With a slit lamp and local anaesthetic, the edge of a needle is used to scrape or scoop the foreign body to remove it
Then covered with chloramphenicol ointment to encourage healing and reduce risk of infection

Question 18

When should you be suspicious of a foreign body penetrating further into he eye?

Answer 18

Irregular pupil
Shallow anterior chamber
Localised cataract
Gross inflammation

Question 19

What is the difference between chemical burns caused by acids and alkalis?

Answer 19

Acid: coagulates proteins, little penentration
Alkali: easy rapid penetration into intra-ocular structures, cicatrising changes to conjunctiva and cornea

Question 20

How are chemical injuries managed?

Answer 20

Washout immediately
Check pH
Irrigate with saline

Question 21

What are the golden rules of ocular trauma?

Answer 21

History is key
Always record visual acuity
Don’t forget fluorescein
Handle suspected globe rupture with care
X-ray orbits if suspicion of intra-ocular foreign body
Immediate irrigation of chemical injuries