Trauma (Ocular Disease)

Question 1

What type of trauma may you see?

Answer 1

1. Chemical burn
2. Conj/corneal FB
3. Hyphema
4. Fracture
5. Commotio Retinae
6. Purscher’s Retinopathy
7. Choroidal Rupture

Question 2

Which burns are worse, alkali or acidic?

Answer 2

ALKALI

These damage FA membranes and therefore penetrate faster through epi

Question 3

What does blanching indicate in a chemical burn?

Answer 3

Ischemia

Question 4

How do you manage a conj/corneal FB?

Answer 4

1. R/O metallic (no MRI) vs non-metallic (veg matter, fungi)
2. Stains w FL
3. Look for underlying infiltrate
4. Seidel sign?

Question 5

What should you consider when you see a hyphema?

Answer 5

1. Systemic disease (i.e. sickle cell)
2. Blood thinners (i.e. warfarin/aspirin)
3. Trauma

Question 6

When would you perform gonioscopy or scleral depression on these pt’s?

Answer 6

1 month POST-injury to AVOID re-bleeding!

NOTE: re-bleeds tend to be WORSE than original presentation

Question 7

When is a B-scan indicated for a hyphema?

Answer 7

If hyphema occludes view of fundus & concerned about RD!

Question 8

What is iridodialysis?

Answer 8

Dis-insertion of IRIS ROOT from CB

Question 9

What is Vossius ring?

Answer 9

Pigment on ANTERIOR lens capsule from trauma

Question 10

What is corectopia?

Answer 10

displacement of pupil (i.e. due to sphincter tear)

Question 11

What is the #1 cause of lens subluxation?

Answer 11

TRAUMA

Question 12

What % of pts w hyphema will also present w angle recession?

Answer 12

60% of cases bc iris pulls away from longitudinal muscle of CB

Question 13

Which bone is most commonly affected in an orbital fracture?

Answer 13

Maxillary bone!

BC orbital FLOOR blow-out fractures are the MOST COMMON due to how weak it is

Question 14

Symptoms of orbital fracture?

Answer 14

1. Pain
2. Diplopia OU
3. CREPITUS on palpation
4. (+) FD
5. Enophthalmos
6. Globe ptosis (don’t blow nose!

Question 15

What is the pathophysiology of commotio retinae?

Answer 15

Disruption of RPE & PR outer segments (grey white discoloration) due to trauma

Question 16

How long does commotio retinae resolve?

Answer 16

24-48 hours!

NOTE: permanent vision/VF loss may occur still

Question 17

Commotio retinae at macula is called what?

Answer 17

Berlin’s edema

Question 18

How do you Tx commotio retinae?

Answer 18

Scleral indent to evaluate for breaks

Question 19

RTC for commotio retinae when?

Answer 19

2 weeks

Question 20

Which traumatic eye disease is associated with compressions of the chest, diffuse retinal hemes, CWS, high IOP, & burst retinal arteries?

Answer 20

Purtscher’s retinopathy

Question 21

Choroidal Ruptures look like what in the retina?

Answer 21

MC a single area or multiple areas of sub-retinal hemorrhage, temporal posterior pole w CRESCENT shaped tears concentric to ONH

Question 22

What may result from a choroidal rupture that affects vision greatly?

Answer 22

CNVM!

Bruch’s membrane is inelastic and more prone to rupture!

Question 23

Tx for choroidal rupture?

Answer 23

Amsler grid: 6-12 months

Anti-VEGF agents