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Ocular Trauma. Sandra M. Brown, MD 1 and Yair Morad, MD 2 1 Ophthalmology and Visual Sciences Texas Tech University Health Sciences Center Lubbock, Texas USA 2 Pediatric Ophthalmology Service, Assaf Harofeh Medical Center, Zrifin, Israel. Nature of Injury. Blunt Lacerating Chemical.

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ocular trauma

Ocular Trauma

Sandra M. Brown, MD1 and Yair Morad, MD2

1 Ophthalmology and Visual Sciences

Texas Tech University Health Sciences Center

Lubbock, Texas USA

2 Pediatric Ophthalmology Service,

Assaf Harofeh Medical Center, Zrifin, Israel

nature of injury
Nature of Injury
  • Blunt
  • Lacerating
  • Chemical
blunt trauma
Blunt Trauma
  • Mild – moderate
    • “Bruise” ocular tissues
    • Eye wall intact
  • Moderate – severe
    • Rupture eye wall
    • Very severe consequences
lacerating trauma
Lacerating Trauma
  • “Cut” eye wall
  • Outcome depends on extent and location
location of injury
Location of Injury
  • Anterior segment
  • Posterior segment
  • Adnexa
  • Orbital structures
anterior segment
Anterior Segment
  • Conjunctiva
  • Cornea
  • Iris
  • Lens
posterior segment
Posterior Segment
  • Vitreous
  • Retina
  • Optic nerve
adnexa
Adnexa
  • Eyelids
  • Lacrimal Structures
orbital structures
Orbital Structures
  • Extraocular muscles
  • Bony walls
disgusting photographs
Disgusting Photographs
  • Front to back…
racoon eye
Racoon Eye
  • Self limiting if no other injury exists
  • No treatment needed
  • Be sure to open lids apart to examine the eye structure and motility
lacrimal duct laceration
Lacrimal Duct Laceration
  • Repair ASAP
  • Probing with silicon tube and suturing
conjunctival trauma
Conjunctival Trauma
  • Sub conjunctival hemorrhage
    • Self limiting
    • No treatment needed
  • Conjunctival laceration
    • Make sure the sclera is intact
    • Antibiotic ointment for 1-3 days
external foreign body
External Foreign Body
  • Can be in conjunctiva or cornea
  • Red painful and watery eye
  • Removal under slit lamp
  • Patching with antb
corneal abrasion
Corneal Abrasion
  • Severe pain and photophobia
  • Blurry vision
  • Erosion stains with fluresceine
  • Patching with antibiotic oint to prevent infection and help re- epithelization
  • Healing 1-4 days
chemical burn
Chemical Burn
  • Usually fat-cleaning materials
  • Pain, photophobia
  • Treatment: irrigation, irrigation, irrigation
corneal penetration
Corneal Penetration
  • Minor wound can be self sealing and leave the eye intact
  • Patient complains on photophobia and pain
  • Only on slit lamp examination perforation is diagnosed
corneal perforation cont
Corneal Perforation -Cont
  • Iris can be captured in the perforation wound
  • Iris reposition if soon after the injury and corneal suturing
hyphema
Hyphema
  • Blood in anterior chamber
  • Sometimes hard to diagnose
  • Blurry vision and pain
  • Self limiting
  • Complications: elevation of intra-ocular pressure and re-bleeding
traumatic cataract
Traumatic Cataract
  • Usually repaired in a secondary operation
  • If possible a plastic intra-ocular lens is inserted instead of the damaged lens
  • Treatment of amblyopia crucial
vitreous hemorrhage
Vitreous Hemorrhage
  • Blood in vitreous cavity
  • Usually self limiting
  • Can be cleared with vitrectomy is rare occasions
intra ocular foreign body
Intra-ocular Foreign Body
  • Ocular emergency
  • Removal in vitrectomy
  • Retained FB can cause infection or retinal degeneration
orbital wall fracture
Orbital Wall Fracture
  • Problematic only if:
    • Limitation of eye ductions
    • Disfiguring enophthalmos
traumatic optic neuropathy
Traumatic Optic Neuropathy
  • Optic nerve injured in optic canal
  • Usually vision loss
  • No good treatment
  • Mega-dose steroids?
common minor eye injuries
Common Minor Eye Injuries
  • Corneal abrasion
  • Corneal foreign body
  • Chemical splash
  • Traumatic iritis
diagnosis
Diagnosis
  • History
    • Sharp vs blunt vs chemical injury
  • Exam
    • CHECK VISION
    • CHECK VISION
    • CHECK VISION
diagnosis cont
Diagnosis cont.
  • Exam – open lids apart!
    • Cornea clear?
    • Pupil round?
    • Pupil black?
    • Blood clotted behind cornea?
diagnosis cont1
Diagnosis cont.
  • Exam
    • Red reflex?
    • Eyes move symmetrically?
fluorescein test
Fluorescein Test
  • Topical “eye dye”
  • COBALT light
abrasion treatment
Abrasion Treatment
  • Antibiotic ointment
  • +/- patch
  • 1-2 day follow-up with eye doc
foreign body treatment
Foreign Body Treatment
  • Anesthetize eye
  • Remove FB
    • Cotton swab (don’t worsen abrasion!)
    • Kimura spatula
    • +/- needle tip
  • Antibiotic oint +/- patch
  • 1-2 day follow-up with eye doc
chemical treatment
Chemical Treatment
  • IRRIGATE with large amounts of water
  • Check PH
  • Minor
    • Antibiotic ointment
    • 1 day follow-up eye doc
  • Major
    • Same day evaluation by eye doc
traumatic iritis
Traumatic Iritis
  • Moderate blunt injury
  • Photophobia
  • Lid bruising/edema
  • Subconjunctival hemorrhage or injection
  • Pupil sluggish
  • Evaluation by eye doc
please do not confuse
Please Do Not Confuse
  • Subconjunctival hemorrhage
  • Hyphema