TOPIC 7: OCULAR HAZARDS 1

Question 1

What kinds of injuries can occur to the eyelids

Answer 1

black eye (periocular haematoma)–self limiting. Due to the damage of the blood vessels and loose connective tissue structure

ptosis may be due to oedematous lid, damage to CN3 or Levator Palpebral Superioris

actropion–Damage to lower eyelid. Prevent the tears from draining properly - ‘tearing’ aka epiphora

Question 2

What kinds of injuries can occur to the Orbit

Answer 2

-Blow out fracture (inferior floor give way)
-zygomatic bone fracture (side wall)
-fractures to the medial wall
-Fractures to the superior wall

Question 3

What kinds of injuries can occur to the Anterior segment

Answer 3

-subconj haemorrhages, usually reasborbed and resolved in few weeks

-hyphema– blood in ant chamber
blood is usually reabsorbed within a few days but ALWAYS REFER
Be careful of total/8 ball hyphema
Colour changes from RED to PURPLE to BLACK
Elevated IOP – secondary glaucoma
Possible blood staining of the cornea (hemosiderosis)
Rebleeding may occur – usually happens 5 days after injury

-iridodialysis–iris torn from its insertion to the ciliary body
Usually accompanied by hyphaema + corectopia
MUST be monitored for glaucoma

-angle recession–ciliary body has been torn from sclera
Gonioscopy and anterior OCT should be performed.
Glaucoma may develop and may only manifest years after the injury

-traumatic cataract
-Vossius ring opacity (“imprinting” of iris pigment on the anterior lens capsule)
-Rosette-shaped cataract (flower shaped cortical opacities)

Question 4

What kinds of injuries can occur to the Posterior segment

Answer 4

-commotio retinae
Confluent area of retinal whitening due to outer segment of photoreceptor disruption and RPE damage
Subsides within 4 days and vision returns to normal
If macula is involved, Berlin’s edema

-choroidal rupture
Common and generally between the disc and macula
May lead to sub-retinal neovascular membrane, so they should be follow up 3-6 months and daily Amsler grid monitoring

-retinal detachment
Floaters + Flashes of light are the hallmark symptoms
Usually the upper temporal retina
(+) tobacco dust particle in the anterior vitreous aka Shafer’s sign

Question 5

How to approach the case if a patient presents with ocular injury

Answer 5

1. Hx taking
   Eye pain ?
   Redness?
2. Ocular Motility
3. Slit-Lamp Examination
   Lid eversion and fluorescein staining are a MUST!!!!!!!!
   Seidel’s sign - this is the leakage of aqueous from the anterior chamber in a penetrating corneal injury.
   Anterior chamber reaction
4. IOP measurement