week 2 ocular trauma

Question 1

mechanism of injury for ocular trauma?

Answer 1

Blunt trauma

Penetrating trauma;
large objects
small objects

Burns:
chemical
physical

Question 2

how do you assess ocular trauma?

Answer 2

good Hx
visual acuities
exam of eye: lids, conjunctiva, cornea, anterior segment, pupils, fundus (use fluorescein drops)

Question 3

what do fluorescein drops do?

Answer 3

identify area of epithelial loss

Question 4

what accounts as negligence for not doing?

Answer 4

Visual acuities

Question 5

what are the 6 golden rules of eye trauma?

Answer 5

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
   (the solution to pollution is dilution!)

Question 6

what does the teardrop sign indicate on CT/MRI?

Answer 6

orbital blowout #

Question 7

what can prolapse due to an orbital blowout #?

Answer 7

orbital fat +/- IR

means they can’t look up

Question 8

what to do in the case of subconjunctival haemorrage

Answer 8

usually self-limiting. leave to settle like any other bruise

Question 9

what to do in idiopathic subconjunctival haemorrhage

Answer 9

check BP (high BP is a cause)

Question 10

what do do in large and boggy subconjuncitval haemorrhage?

Answer 10

suspect globe rupture, investigate under anaesthetic (fix if necessary by surgery)

HANDLE SUSPECTED GLOBE RUPTURE WITH CARE… (AS MAY PROPLASE OUTWARDS VITURAL/RETINA)

Question 11

WHY DOES TRAUMATIC UVEITIS occur?

Answer 11

iris muscle becomes inflamed and breaks down the blood aqueous barrier, proteins then lookout of damaged vessels into ant.chaber and inflammation occurs giving red eye and uveitis

Question 12

what is a Hyphaema?

Answer 12

blood in ant.chamber

Question 13

what to do with a hyphaema?

Answer 13

caused by serious injury - investigate further

Question 14

in severe trauma tearing of theintra-ocular structures can occur. what structures are normally torn?

Answer 14

limbus.

zonules (causes a dislocated lens)

Question 15

retinal detachment 2 types what are they?

Answer 15

very short sighted people

trauma

Question 16

what occurs in a retinal detachment

Answer 16

fluid gets under retina and it peels away

Question 17

what causes optic nerve avulation?

Answer 17

rare,

trying to remove someones eye forcefully

Question 18

choroidal tear key facts

Answer 18

rare, can’t really treat it.

Question 19

what is Commotio Retinae? treatment?

Answer 19

“Bruised retina” - due to severe trauma

settles over time but if involves macula may never fully recover vision (central and severe)

Question 20

how can you investigate Severe intra-ocular disruption

Answer 20

US probe - if have no idea what’s going on

Question 21

what to do in large penetrating object in the eye?

Answer 21

multi-displinary team approach

Question 22

one case of a lid laceration

Answer 22

dog attack on kid

Question 23

corneal laceration how to investigate?

Answer 23

fluorescene in eye, will see leaking injury= siedels test

Question 24

what is seidels test used for?

Answer 24

used to assess the presence of anterior chamber leakage in the cornea. It is used as a screening test for many corneal disorders including corneal post-trauma, corneal perforation and corneal degeneration. (corneal LACERATION)

Question 25

what is a teardrop pupil shape as sign of? why does it occur?

Answer 25

corneal laceration.

iris can plug up the gap

Question 26

what to do with scleral laceration?

Answer 26

repair under anaesthetic, surgical closure

Question 27

what to do in fish hook injury?

Answer 27

occurs in fly fishers

surgery; do not pull hook out

Question 28

what causes Sympathetic ophthalmia

Answer 28

Penetrating injury to one eye

exposure of intra-ocular antigens auto-immune reaction in both eyes.

Question 29

where do small particles/foreign bodies commonly affect the eye?

Answer 29

painful but okay = Sub-tarsal
Conjunctival
Corneal

potentially serious + visually debilitating = Intra-ocular
Intra-orbital

Question 30

what is an ICE RINK CORNEA as sign of?

Answer 30

metal foreign body every time you blink scraping the cornea

Question 31

how to treat a corneal abrasion/FB

Answer 31

anaesthetic, remove FB, chloramphenicol drops (4x daily for 1 week)

Question 32

when should you be more suspicious of a Penetrating foreign body

Answer 32

Pupil irregular
Anterior Chamber shallow (low IOP)
Localised cataract (trauamtic and acute)
Gross inflammation.

Question 33

Intra-ocular foreign body (IOFB) how to investigate? commonly caused by?

Answer 33

Always X-ray potential IOFBs (good history)

Fast moving particles
eg hammer and chisel injuries (glasses not 100% effective)

Question 34

what two types of chemical burns to the eye are there? which is worse?

Answer 34

acid and alkali. alkali worse because acid coagulates proteins, does little penetration and is self limiting

Question 35

why are alkali chemical burnt to the eye worse?

Answer 35

• cicatrising changes to conjunctiva and cornea
• penetrates the intra-ocular structures
• easy, rapid penetration

Question 36

what is a bad prognostic sign in an alkali burn?

Answer 36

Alkali burns look less severe than acid but cause ischaemia.

ischaemia around the limbus very bad (as that is where the corneal stem cells are - means scarring is worse)

Question 37

after a chemical burn what causes problems with vision?

Answer 37

scarring affects vision

Corneal vascularisation is a sign of chronic scarring

end stage scarring is where lids close over and conjunctiva covers cornea

Question 38

how to manage chemical injury?

Answer 38

Assessment of chemical injury occurs after thorough irrigation.

quick Hx (chemical, when, irrigation at event?)
check Toxbase
check pH
IMMEDIATE irrigation = 2l of saline or until pH is normal
THEN…assess with silt lamp

Question 39

what to do if Lime / Cement dust in eye?

Answer 39

remove physically as using water creates alkaline solution