Trauma

Question 1

What are the 3 types of injury that commonly affect the eye

Answer 1

Blunt trauma
Penetrating trauma
Burns - physical and chemical

Question 2

How are fluorescein drops used

Answer 2

Stain the eye
Taken up by areas where there is an epithelial defect - e.g. corneal abrasion
Shows up under blue light

Question 3

What is a blow-out fracture

Answer 3

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

Question 4

What muscle is commonly damaged by a blow-out fracture

Answer 4

Inferior rectus
It can get trapped in the healing fracture
Patient will no longer be able to look up

Question 5

What is a white eye fracture

Answer 5

Common occurrence in children
It is a blow-out fracture with no other clinical signs beside the inferior rectus damage
No bruises or haemorrhages

Question 6

What is a hyphaema

Answer 6

Blood in the anterior chamber of the eye
Indicates severe trauma
Will eventually form a fluid level

Question 7

How can a lens dislocate

Answer 7

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

Question 8

How does retinal detachment occur

Answer 8

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

Question 9

Retinal detachment can cause visual loss - true or false

Answer 9

True

Can be repaired though

Question 10

What is commotio retinae

Answer 10

Bruising of the retina

Usually settles by itself

Question 11

What is a clear sign of a corneal laceration

Answer 11

Change in the pupil shape

Question 12

How can you test for a penetrating injury to the eye

Answer 12

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

Question 13

What is sympathetic ophthalmia

Answer 13

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

Question 14

Where is a sub-tarsal foreign body found

Answer 14

On the underside of the eyelid - may be felt but not not seen on exam
Easy to remove by everting the upper lid

Question 15

How would you remove a conjunctival or corneal foreign body

Answer 15

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

Question 16

What signs are suggestive of a penetrating foreign body

Answer 16

Pupil irregular or distorted
Anterior Chamber shallow
Localised cataract
Gross inflammation
Hyphema
High velocity mechanism of injury

Question 17

What must you do if a intra-ocular foreign body is suspected

Answer 17

X-ray the patient

Question 18

Describe the effect of acid on the eye

Answer 18

Coagulates the proteins
Little penetration
Actually causes fewer problems

Question 19

Describe the effect of alkali on the eye

Answer 19

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

Question 20

What does the limbus contain

Answer 20

Stem cells

Question 21

What is the sign of eye ischaemia

Answer 21

A china white eye

No sign of any vasculature

Question 22

What is the major consequence of eye ischaemia

Answer 22

Corneal scarring

Vision is usually affected

Question 23

How do you manage a chemical eye injury

Answer 23

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

Question 24

What are the golden rules of eye trauma

Answer 24

1. History is key
2. Always record visual acuity
3. Don’t forget Fluorescein
4. Handle suspected globe rupture with care…
5. X-Ray orbits if suspicion of Intra-Ocular Foreign Body (IOFB)
6. Immediate irrigation of chemical injuries

Question 25

Foreign bodies in the eye can cause extreme pain even if small - true or false

Answer 25

True

Especially if in the cornea or sub tarsal area

Question 26

What examinations should be performed if a foreign body is suspected

Answer 26

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

Question 27

What actions must you take if you find a penetrating injury to the eye

Answer 27

Refer to an Ophthalmologist
Protect the eye
X-Ray orbits if time permits – do not MRI

Question 28

Which type of foreign body has the highest infection risk

Answer 28

Organic material - e.g. plant material in agricultural
injuries
May cause fungal infection.

Question 29

Metallic foreign bodies can cause what effect in the eye

Answer 29

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

Question 30

List signs of blunt injury to the eye

Answer 30

Hyphaema - blood in anterior chamber 
Iris damage
Lens dislocation 
Vitreous haemorrhage
Retinal damage
Scleral rupture

Question 31

What is an eye flashburn

Answer 31

UV burn to the eye

Can be caused by welding and sun beds