Severe eye trauma **** Flashcards
Define a globe rupture (aka open globe)?
Blunt or penetrating trauma resulting in complete break in the cornea or sclera
Type of closed globe injuries
Lacerations (conjunctiva or partial thickness scleral/corneal)
Corneal/conjunctival abrasions (can be sight-threatening if chemical or become infected)
Bleeding (hyphema, vitreous haemorrhage)
Displacement (lens dislocation, retinal detachment)
Type of periocular injuries
Lacerations
Fractures
Nerve/artery injuries
What may severe periocular bleeding or inflammation cause?
Orbital compartment syndrome (OCS)
Raised IOP which leads to ocular ischaemia
Burns:
Chemical burns - how is it treated?
What might the patient do due to the immense pain?
What type of burn is worse, alkali or acid?
- Anaesthetic drops every 2 minutes until the patient is comfortable
- Bathe eyes in clear water
Close their eyes tightly
Alkali
Burns:
Chemical burns - how is it treated?
What might the patient do due to the immense pain?
What type of burn is worse, alkali or acid?
- Anaesthetic drops every 2 minutes until the patient is comfortable
- Copious saline irrigation 20-30 mins then check pH
Close their eyes tightly
Alkali
Photokeratitis ‘arc eye’:
What type of worker gets this?
What is the pain compared to?
How long after exposure does pain begin?
You give them oral analgesia. Why do you not give them analgesic eye drops?
Welders and sunbed users who don’t use UV protection which damages the cornea
Childbirth
6-12 hours after exposure
Ocular toxicity due to overuse
Intraocular bleeds:
Where is blood often found?
Why do these need to be monitored very carefully?
Anterior chamber (hyphaema)
Can progress to glaucoma, corneal staining and re-bleeding
Secondary haemorrhage:
Why might this be sight-threatening?
What is traumatic mydriasis?
What will a vitreous haemorrhage affect? - 2
Can progress to secondary glaucoma
Paralysed and dilated pupil due to injury - may be permanent
Vision and red reflex
Blow out fracture:
Blunt injury (e.g. from a football) may cause a sudden increase in IOP - what could this lead to?
Why does tethering of inferior rectus and inferior oblique muscles cause?
Why do you test sensation on the lower eyelid?
Herniation of orbital contents into the maxillary sinus
Diplopia
Infra-orbital nerve injury which confirms a blow fracture
Examination findings - globe rupture:
What may you see coming from the eye?
What might happen to the pupil?
The choroid might prolapse or plug through the wound. What would this look like?
What is the Seidel test and why is it done?
Foreign body
Peaked pupil and iris
Blue/brown/black on eye surface
Applying fluorescein dye to the eye - if positive, you will see green aqueous humour which should be inside the cornea
Examination findings - Occipital compartment syndrome (OCS):
What is the first thing you might notice when you meet the patient?
What would you find on tonometry?
What will the patient complain about?
Type of pupillary defect?
Proptosis - same as exophthalmos for Graves
Raised IOP
Decreased visual acuity
Eyelids which are hard to close - ptosis
Relative afferent pupillary defect (RAPD)
Imaging:
What imaging can be done if you suspect rupture, OCS (treat before imaging), orbital foreign body, orbital fracture etc?
Orbital CT
Management - Globe rupture:
How to minimize IOP?
How should the patient lie down?
What should be used to minimize N&V?
What should be placed on the eye to protect it?
What will eventually be needed?
No eyelid retraction or tonometry
Raise the head of the bed
Anti-emetics
Eyeshield - not patch - look up
Urgent surgical repair
Management - OCS:
What is an emergent lateral canthectomy and inferior cantholysis?
What else can be managed to minimize IOP?
The emergency treatment for OCS is the surgical exposure of the lateral canthal tendon. Cantholysis is canthotomy plus incision of the inferior branch (crus) of the tendon.
Look up
BP
