Traumatic eye emergencies
This presentation is the property of its rightful owner.
Sponsored Links
1 / 37

Traumatic Eye Emergencies PowerPoint PPT Presentation


  • 49 Views
  • Uploaded on
  • Presentation posted in: General

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

Download Presentation

Traumatic Eye Emergencies

An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -

Presentation Transcript


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 do you find

What do you find?


What is the likely dx

What is the likely dx?

Metallic Foreign Body (FB) to the eye


What is the most important point in examination

What is the most important point in examination ?

Visual Acuity


If a corneal fb iron dust is found

If a corneal FB (iron dust) is found...

  • What is the treatment?


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

Remove FB with

a moistened

cotton tip


Irrespective of whether a fb is found

Irrespective of whether a FB is found

What further test is necessary?


Stain for cornea abrasion

Stain for cornea abrasion

What is the treatment for this?


Corneal abrasion

Corneal abrasion

  • 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?

Subconjunctival FB-- a piece of wood

Penetration of globe should be R/O


Think about ruptured globe if

Think about ruptured globe if …

  • 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


Seidel s test

Seidel’s test


How to manage fb associated globe rupture

How to manage FB associated globe rupture?

  • 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

What would you do next ?


X ray orbit for io fb

X-ray orbit for IO FB

High velocity FB e.g. hammer & chisel injury


Case 2

Case 2

  • 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

  • Cornea

  • Anterior chamber

  • Lens

  • Vitreous

  • Retina

  • Visual field

  • EOM


Corneal laceration

Corneal laceration


What about this eye

What about this eye ?

What else do you need to check?


Hyphema

Hyphema

  • <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


Visual prognosis

Visual prognosis


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?


Bottom line blunt injury va

Bottom line: Blunt injury +  VA

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


Case 3

Case 3

  • 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


What is the most important property about the chemical that we need to know

What is the most important property about the chemical that we need to know ?

pH


Which is worse acid or alkali

Which is worse? Acid or alkali

  • Alkali can cause persistent injury

  • liquefactive necrosis

How do you test for pH ?


Testing for ph

Testing for pH

What is the normal

pH for tear?


What should be our ed tx

What should be our ED Tx ?


Irrigation till ph normalise

Irrigation till pH normalise

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

  • Alkali burn

  • impaired VA

  • Corneal stain +ve


Summary

Summary

We have covered:

1. Eye injuries due to FB

2. Blunt eye trauma

3. Chemical injury


The end

The end


  • Login