ocular trauma and emergencies Flashcards
types of injuries in blunt trauma to anterior segment
- subconjunctival haemorrhage
- corneal abrasion
- hyphema
- traumatic cataract
- anterior dislocation of lens
corneal abrasion symptoms and inx
acute pain, use fluorescein staining of cornea and cobalt blue filter on slit lamp examination
mx of corneal abrasion
- topical cycloplegic to relieve pain
- topical abx
- pressure patch over eye
- bandage contact lenses (if defect large)
warn of recurrent corneal erosion (constant corneal abrasion)
what is hyphema
accumulation of blood in anterior chamber from damage to root of iris, may be a/w ↑ IOP
hyphema mx
- RO occult globe rupture
- apply eye shield (don’t patch!)
- refer
- Rest with head upright
- topical steroids, cycloplegics, antiglaucoma
- surgical drainage if persists or re-bleeds.
injuries in blunt trauma to posterior segment
- commotio retinae
- retinal breaks/dialysis
- vitreous haemorrhage
- macular hole
- choroidal rupture
- globe rupture
where is commotio retinae?
- periphery
- berlin edema if occurs in centre involving fovea
commotio retinae mx
innocuous, resolves within few weeks, prognosis good unless got choroidal rupture
globe rupture signs and symptoms
1. lid edema
2. chemosis
3. hyphema
4. shallow or deep AC
5. vitreous haemorrhage (causes loss of red reflex)
6. hypotony (↓ IOP)
7. uveal prolapse
types of injuries in blunt trauma to orbit
- floor or orbit # / orbital blow out # (commonest)
- white eyed blow out (children)
CT findings of blunt trauma to orbit injuries
Herniation of orbital contents, periorbital fat and inferior rectus (and/or oblique muscles) into maxillary sinus (tear drop sign)
Thin cut coronal CT is imaging of choice
signs and symptoms of blunt trauma to orbit injuries
- Periorbital ecchymosis
- enophthalmos
- infraorbital nerve paresthesia (infraorbital area and upper lip)
- entrapment of inferior rectus and/or oblique muscles causing restriction of EOM (e.g. elevation)
- vertical diplopia
indications for surgery in blunt trauma to orbit injuries
- # >50% floor
- diplopia not improving
- significant enophthalmos (≥ 2mm)
- entrapment in young children
types of penetrating trauma
- Eyeball laceration
- Ruptured globe
- Prolapsed iris
- Foreign bodies
inx and findings in FBs in penetrating trauma
inx: CT head and orbit
findings: intracranial and intraocular FB from high-velocity injury (e.g. hammering if Hx of metal on metal given)