Trauma Flashcards
What are the 3 types of injury that commonly affect the eye
Blunt trauma
Penetrating trauma
Burns - physical and chemical
How are fluorescein drops used
Stain the eye
Taken up by areas where there is an epithelial defect - e.g. corneal abrasion
Shows up under blue light
What is a blow-out fracture
Fracture of inferior orbital floor - weakest portion
Usually due to blunt trauma to the eye
Ocular fat can herniate through the injury - tear drop sign
What muscle is commonly damaged by a blow-out fracture
Inferior rectus
It can get trapped in the healing fracture
Patient will no longer be able to look up
What is a white eye fracture
Common occurrence in children
It is a blow-out fracture with no other clinical signs beside the inferior rectus damage
No bruises or haemorrhages
What is a hyphaema
Blood in the anterior chamber of the eye
Indicates severe trauma
Will eventually form a fluid level
How can a lens dislocate
The zoonules are fibres that hold the lens in place
If enough are disrupted, the lens can move out of place
Will cause visual disturbance
How does retinal detachment occur
Vitreous gel pulls on the retina and creates a small tear
Fluid gets behind the retina and causes the rest of it to peel off
Can occur secondary to trauma
Retinal detachment can cause visual loss - true or false
True
Can be repaired though
What is commotio retinae
Bruising of the retina
Usually settles by itself
What is a clear sign of a corneal laceration
Change in the pupil shape
How can you test for a penetrating injury to the eye
Add fluroscein dye to the eye
If there is a leak, it will become diluted due to aqueous fluid spilling out of the wound
Called Sidel’s sign
What is sympathetic ophthalmia
Penetrating injury to one eye can lead to inflammation of both eyes
Thought that antigen exposure can cause reaction in both eyes
May lead to bilateral blindness
Where is a sub-tarsal foreign body found
On the underside of the eyelid - may be felt but not not seen on exam
Easy to remove by everting the upper lid
How would you remove a conjunctival or corneal foreign body
Instill local anesthetic
Loosely adherent FBs may be removed using a wet cotton bud
Use a needle under magnification to scoop it out of the eye
Give a topical antibiotic and topical NSAIDs for pain
What signs are suggestive of a penetrating foreign body
Pupil irregular or distorted Anterior Chamber shallow Localised cataract Gross inflammation Hyphema High velocity mechanism of injury
What must you do if a intra-ocular foreign body is suspected
X-ray the patient
Describe the effect of acid on the eye
Coagulates the proteins
Little penetration
Actually causes fewer problems
Describe the effect of alkali on the eye
Particularly dangerous Easily and rapidly penetrates the eye Can completely alter pH of inner eye Penetrates the intra-ocular structures Can cause conjunctival ischaemia and corneal vasculairation and scarring
What does the limbus contain
Stem cells
What is the sign of eye ischaemia
A china white eye
No sign of any vasculature
What is the major consequence of eye ischaemia
Corneal scarring
Vision is usually affected
How do you manage a chemical eye injury
Check pH - litmus paper
Irrigate with saline - LOTS until pH is neutral
Refer to opthalmology
Quick history to try and determine chemical
Check toxbase
Assess with a slit lamp
What are the golden rules of eye trauma
- 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 (IOFB)
- Immediate irrigation of chemical injuries
Foreign bodies in the eye can cause extreme pain even if small - true or false
True
Especially if in the cornea or sub tarsal area
What examinations should be performed if a foreign body is suspected
Visual acuity Subtarsal conjunctiva (evert upper lid) Cornea Conjunctiva including the lower fornix Instil fluorescein to show any abrasions or scratches Look at the pupil shape Look for a hyphaema
What actions must you take if you find a penetrating injury to the eye
Refer to an Ophthalmologist
Protect the eye
X-Ray orbits if time permits – do not MRI
Which type of foreign body has the highest infection risk
Organic material - e.g. plant material in agricultural
injuries
May cause fungal infection.
Metallic foreign bodies can cause what effect in the eye
If lodged in the cornea, can cause a rust ring.
Should be removed to avoid permanent corneal staining.
Also more likely to cause ocular penetration
List signs of blunt injury to the eye
Hyphaema - blood in anterior chamber Iris damage Lens dislocation Vitreous haemorrhage Retinal damage Scleral rupture
What is an eye flashburn
UV burn to the eye
Can be caused by welding and sun beds
