Traumatic eye emergencies
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HKCEM College Tutorial. Traumatic Eye Emergencies. Author Dr. TW Wong revised by Dr. Lam Pui Kin, Rex Oct., 2013. Objectives. Understand how to manage Eye injuries due to foreign body Blunt eye trauma Chemical injury. Case 1. M 40 R Eye discomfort after ? FB to eye

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Traumatic eye emergencies

HKCEM College Tutorial

Traumatic Eye Emergencies

Author

Dr. TW Wongrevised by

Dr. Lam Pui Kin, Rex

Oct., 2013


Objectives
Objectives

Understand how to manage

  • Eye injuries due to foreign body

  • Blunt eye trauma

  • Chemical injury


Case 1
Case 1

  • M 40

  • R Eye discomfort after ? FB to eye

  • Drilling with an electric drill

  • Tearing ++



What is the likely dx
What is the likely dx?

Metallic Foreign Body (FB) to the eye




Metallic fb in cornea
Metallic FB in cornea

  • Should be removed under topical LA

  • In hospitals without urgent eye support, removal of non-axial FB can be attempted

  • Axial/ full thickness FB should be removed by eye specialists

  • rust ring need to be removed to prevent siderosis

  • antibiotic eyedrop +/- mydriatic

  • ATT

  • eye pad is not necessary


If no obvious fb is noted where else should you look for an fb
If no obvious FB is noted, where else should you look for an FB

How?

Upper fornix by everting eyelid


Fb upper fornix
FB upper fornix FB

Remove FB with

a moistened

cotton tip


Irrespective of whether a fb is found
Irrespective of whether a FB is found FB

What further test is necessary?


Stain for cornea abrasion
Stain for cornea abrasion FB

What is the treatment for this?


Corneal abrasion
Corneal abrasion FB

  • LA eye drop (e.g. novesin) stat for pain control

  • antibiotic eye drop

  • oral analgesic prn

  • ATT

  • urgent referral for eye FU

  • no need for patching


What about this patient
What about this patient? FB

Subconjunctival FB-- a piece of wood

Penetration of globe should be R/O


Think about ruptured globe if
Think about ruptured globe if … FB

  • High velocity projectiles

  • Shallow anterior chamber

  • Hyphema

  • Irregular pupil or the pointing sign

  • Prolapsed iris

  • Bullous subconjunctival hemorrhage

  • Lens dislocation or opacification

  • Siedel test

  • Vitroeus hemorrhage

  • Retinal detachment



How to manage fb associated globe rupture
How to manage FB associated globe rupture? FB

  • Avoid pressure over injured globe

  • Supine

  • Rigid eye shield

  • Leave FB undisturbed

  • IV antibiotics

  • Pain control +/- antiemetic

  • ATT

  • NPO

  • Urgent Ophthalmologist consult


You only find subconjunctival hemorrhage
You only find subconjunctival hemorrhage FB

What would you do next ?


X ray orbit for io fb

X-ray orbit for IO FB FB

High velocity FB e.g. hammer & chisel injury


Case 2
Case 2 FB

  • M 25

  • Injury R eye

  • Hit by the badminton cock by accident during a game

  • R eye pain with VA impaired


Exam for acute va loss
Exam for acute VA loss FB

  • Cornea

  • Anterior chamber

  • Lens

  • Vitreous

  • Retina

  • Visual field

  • EOM



What about this eye
What about this eye ? FB

What else do you need to check?


Hyphema
Hyphema FB

  • <20% in this patient

  • total hyphema => visual loss

  • rest in an upright position advised

  • urgent eye consult needed

  • Watch out for associated injuries and complications



What if the patient complains of floaters and flashes only with no obvious external injuries
What if the patient complains of floaters and flashes only with no obvious external injuries?

Consider retinal detachment until proven otherwise


What bedside investigation may help in diagnosis
What bedside investigation may help in diagnosis? with no obvious external injuries?


Bottom line blunt injury va
Bottom line: Blunt injury + with no obvious external injuries? VA

Urgent referral to eye is necessary even if exam is normal in ED


Case 3
Case 3 with no obvious external injuries?

  • F 35

  • unknown chemical spilled into eye

  • severe pain at first

  • irrigation done with tap water in workplace

  • VA difficult to test due to blepharospasm



Which is worse acid or alkali
Which is worse? Acid or alkali we need to know ?

  • Alkali can cause persistent injury

  • liquefactive necrosis

How do you test for pH ?


Testing for ph
Testing for pH we need to know ?

What is the normal

pH for tear?


What should be our ed tx
What should be our ED Tx ? we need to know ?


Irrigation till ph normalise
Irrigation till pH normalise we need to know ?

LA eye drop

Eye retractor

NS via drip

Remember to retract lids and swab fornicesfor particulate matter


Urgent refer to eye for all cases
Urgent refer to eye for all cases we need to know ?

  • Alkali burn

  • impaired VA

  • Corneal stain +ve


Summary
Summary we need to know ?

We have covered:

1. Eye injuries due to FB

2. Blunt eye trauma

3. Chemical injury


The end
The end we need to know ?


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