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eye trauma approach and management
This document provides information on eye injuries, including common forms, injury sites, symptoms, examination findings, and treatment. It discusses injuries to structures like the conjunctiva, cornea, iris, lens, vitreous, retina, optic nerve, as well as chemical injuries. Examination is important to determine the type and extent of injury. Treatment depends on the specific injury but often involves irrigation, antibiotics, patching, and repair of lacerations or detached retinas. Some injuries like retinal tears or iron foreign bodies can lead to long term complications if not addressed.
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Objectives include identifying common eye injuries and examination methods. Types are foreign body, blunt trauma, penetrating trauma, and chemical trauma.
Do not touch or rub the eye or try to remove objects. Symptoms include pain, watering, and blurred vision.
Examination varies based on injury type; visual acuity assessment is crucial. Lid injuries may involve hematoma or laceration requiring suturing.
Corneal injuries include abrasions and foreign bodies. Treatment may involve antibiotics and pupil dilation. Hyphaema is a notable complication.
A ruptured globe requires emergency treatment, avoiding pressure and administering sedation. Rigid shields are recommended during transport.
Trauma may cause miosis or mydriasis, and conditions like traumatic iritis or sphincter tears may occur.
Injuries can lead to temporary myopia, angle recession glaucoma, and cataracts, indicating severe trauma.
Vitreous hemorrhage requires monitoring or vitrectomy. Traumatic optic neuropathy causes vision loss with no available treatment.
Choroidal ruptures may cause asymptomatic or visual acuity decrease. Commotio retinae follows blunt trauma, with potential retinal detachment.
Penetrating injuries result in mechanical damage and potential infection; foreign bodies like metal can severely affect vision.
Chemical injuries, especially from alkali, are severe. Immediate irrigation is crucial, with further treatments including steroids and possible surgery.
Eye health reflects beauty; injuries must be managed swiftly to prevent complications.
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eye trauma approach and management
- 2. Objectives OTo know thecommon forms of eye injury OHow to take a hx, to do physical examination OTo know the possible sites of injury and to take a general idea of each one
- 3. Numbers OOcular trauma isthe cause of blindness in about half a million people worldwide. O50% of the total injuries occur in patients less than 25 yrs of age and 9-34% of them in pediatric group. O-M>>F 4:1
- 4. Forms of injury OForeignbody injury OBlunt trauma OPenetrating trauma OChemical trauma ( acidic or alkali )
- 5. Injury sites OAnterior segment(Conjunctiva, Cornea, Iris, Lens) OPosterior segment (Vitreous, Retina , Optic nerve) OAdnexa (Eyelids, Lacrimal Structures ) OOrbital structures (Extraocular muscles bony walls )
- 7. Befor everything For alleye injuries: ODO NOT touch, rub or apply pressure to the eye. ODO NOT try to remove the object stuck in the eye. ODo not apply ointment or medication to the eye. OSee a doctor as soon as possible, preferably an ophthalmologist
- 8.
- 9. Symptomes and signs OThepatient ā s symptoms will relate to the degree and type of trauma suffered. OPain, lacrimation and blurring of vision, red eye are common features of trauma Omild symptoms obscure a foreign body injury
- 10. Examination OThe examination willdepend on the type of injury. In all cases it is important that visual acuity is recorded in the injured and uninjured eye for medico ā legal reasons OWithout a slit lamp OWith a slit lamp
- 11. Orbital injury OEmphysema Opatch ofparaesthesia OLimitation of eye movements Oenophthalmos :the eye may become recessed into the orbit
- 13. Lid injury OHematoma (traumaticblack eye) Olaceration
- 14. Lid laceration Tx OSuturingto retain lid contour OIf one of the lacrimal canaliculi is damaged an attempt can be made to repair it, but if repair is unsuccessful, usually the remaining tear duct is capable of draining all the tears. OIf both canaliculi are involved, an attempt at repair
- 15. Conjunctival injury OChemosis (edemaof conjunctiva) OLaceration OSubconjunctival hemorrhage
- 16. Corneal injury OAbrasion OForeign body ORupture Orecurrentcorneal erosion.
- 17. Abrasion Most common eyeinjury Oloss of the epithelial layer OTypical causes: fingernails, mascara brushes, debris, chemical injuries, extended use of contact lenses, iatrogenic OThe instillation of fluorescein will identify the extent of an abrasion
- 19. Corneal abrasion Tx OProphylacticantibiotic ointment, with or without an eye pad. ODilatation of the pupil with cyclopentolate 1% can help to relieve the pain caused by spasm of the ciliary muscle
- 20.
- 21. FB Tx Oremoved witha needle under topical anesthesia OSub tarsal objects can often be swept away with a cotton - wool bud from the everted lid. OThe patient is then treated as for an abrasion. O-If Injury penetrated the globe, eye should be examined carefully with dilation of pupil Oto see the lens and retina
- 22. Anterior chamber OHyphaema :accumulation of blood in anterior chamber Ocaused by rupture of the root of the iris blood vessels, or iris dialysis (Torn away from its insertion to ciliary body) COMPLICATIONS Ore-bleeding (5-6 days after injury), Oincreased IOP Ocornea staining with blood and traumatic mydriasis
- 24. Tx -Children needs hospitaladmission for few days -Adult treated at home -REST !!! -Steroids decrease risk of rebleeding , BB ,pupil dilation. ( No aspirin or NSAID) -usually responds to medical treatment, but occasionally surgical intervention is required
- 25. Rupture globe (Scleral rupture) Ooccurswhen the integrity of the outer membranes of the eye is disrupted by blunt or penetrating trauma Oophthalmologic emergency Ooccur when a blunt object impacts the orbit, compressing the globe along the anterior-posterior axis causing an elevation in intraocular pressure to a point that the sclera tears
- 26. Rupture globe (Scleral rupture) Itis critical to avoid putting pressure on a ruptured globe to prevent any potential extrusion of intraocular contents and to avoid further damage ODecrease in visual acuity, pain ,watering, redness. ODecrease in anterior chamber depth. ODecrease in IOP OIn penetrating injuries the shape of the pupil may be distorted if the peripheral iris has plugged a penetrating corneal wound (uveal prolapse)26
- 28. Treatment OPrehospital OA suspected orobvious ruptured globe should be protected from any pressure or inadvertent contact with a rigid shield during transport. OImpaled foreign bodies should be left undisturbed. OEye patches are contraindicated
- 29. Treatment OER OPlace Fox eyeshield or other rigid device OAdminister antiemetics (eg, ondansetron) to prevent Valsalva maneuvers OAdminister sedation and analgesics as needed
- 30. OAvoid any topicaleye solutions (eg, fluorescein, tetracaine, cycloplegics) in cases of known globe perforation or rupture OAdminister prophylactic antibiotics OEnsure the patient is kept nothing by mouth (NPO)
- 31. Pupil OTraumatic miosis (dueto iridocyclitis, It occurs initially due to irritation of ciliary nerves OTraumatic mydriasis (due to 3rd nerve palsy) + -blurring of vision (loss of accommodation).
- 32. Iris OTraumatic iritis: inflammationof iris and ciliary body after any type of trauma due to exposure of antigens. OTraumatic sphincter tears defects in constrictor pupillae muscle at the pupillary border , V- shaped tears (avoid mydriatics) OIridodialysis separation of the root of iris from its insertion on the ciliary body, produce a D-shaped pupil Otraumatic aniridia
- 34. Ciliary body OTraumatic spasmor paralysis of accommodation ... temporary myopia OHypotony ; suppression of secretion of aqueous humour OAngle recession glaucoma (2ry glaucoma) onset is often delayed
- 35. Lens OSubluxation of thelens . It may occur due to partial tear of zonules. The subluxated Lens is slightly displaced but still present in the pupillary area O Odislocation >>fluttering of the iris diaphragm on eye movement (iridiodonesis) OTraumatic cataract after blunt or penetrating injury (Posterior sub-capsular), within hours and transient OStar or stellate shape appears Vossiusā Ring
- 37. Vitreous OHemorrhage If thereis no red reflex and no fundus details are visible, this suggests a vitreous hemorrhage OFloaters OFloaters and spots typically appear when tiny pieces of the vitrous break loose within the inner back portion of the eye. OProlapse
- 39. Vitreous hemorrhage Vitreous HemorrhageTreatment: Omay absorb over several weeks, or may require removal by vitrectomy
- 40. Optic nerve OTraumatic opticneuropathy caused by avulsion of the blood vessels supplying the optic nerve. OAlthough this is uncommon, it leads to a profound loss of vision and no treatment is available. Ooptic nerve atrophy is often seen 3-6 weeks after the injury.
- 42. Choroid O-Rupture: linear rupture,white lines, edges may be covered with hemorrhage. (Asymptomatic or decrease in Visual Acuity) O-Traumatic choroiditis O-Effusion or hemorrhage may occur under the Oretina (subretinal) or may even enter the vitreous Oif retina is also torn. O-Spontaneous choroidal detachment: Odue to hypotony
- 43. Retina OCommotio retinae damageto the outer retinal layers caused by shock waves that traverse the eye from the site of impact following blunt trauma OUnder examination the ritina appears opaqe and white in colour most commonly seen in the posterior pole and may seen in the periphery but the blood vessles are normally seen Ocharacterized by decreased vision in the injured eye a few hours after the injury
- 44. Symptoms 1. spontaneous recoveryin 3-4 weeks 2. visual recovery is limited if associated with macular involvement 3. degeneration, macular holes, choroidal rupture Signs 1. whitish-grayish opacification 2. scattered retinal hemorrhages 3. cherry red fovea
- 45. Retina Commotio retinaeTreatment of OItusually spontaneously resolves, but requires careful observation since retinal holes may develop in affected areas and may lead to subsequent retinal detachment.
- 46. ORetinal tears orretinal dialysis ORetinal detachment ORetinal hemorrhage 46
- 47. Retina Treatment of Retinaldialysis: Osurgical intervention to repair any detached retina
- 48.
- 49. Penetrating Trauma Clinical effects 1.Mechanical: Owounds on cornea, conjunctiva and-sclera OUveal prolapse Otraumatic cataract 2. Infection: severe in 24-48 hrs., fungal delayed 3. Sympathetic ophthalmia: diffuse bilateral uveitis of both eyes after trauma to one eye, may develop in days and up to several yearsā¦ Blindness Symptoms may develop from days to several years after a penetrating eye injury 49
- 50. Examination: Oeyes should begently examined OAvoid direct pressure on globe .
- 51. IOFB OMetallic vs nonmetallic ORetained, iron - containing foreign bodies may have an insidious and particularly devastating effect on the eye (siderosis oculi).Due to generation of free radicals lead to Oa progressive, pigmentary degeneration of the retina. OA discoloration of the iris (heterochromia) , Oa fixed mydriasis , Ocataract can be a late clues to the diagnosis.
- 52. OFailure to detectand remove such a foreign body at the time of injury results in irreversible blindness OCopper containing foreign bodies causes keyser feischer rings and endophthalmitis
- 53. Chemical injury OAlkali moresevere than acids because they penetrate more. OThe conjunctiva may appear white and ischemic. If such changes are extensive, involving the greater part of the limbal circumference, corneal healing will be grossly impaired because of damage to the epithelial stem cells of the cornea, which are located at the limbus 53
- 54. Chemical injury OA prolongedepithelial defect may lead to a corneal āmeltā (keratolysis) OThere will be additional complications such as uveitis, secondary glaucoma and cataract.
- 55. Chemical injury Treatment : OThemost important part of the treatment is to irrigate the eye immediately with COPIOUS quantities of clean water at the time of the accident. Oirrigate under the upper and lower lid to remove solid particles Onature of the chemical can then be ascertained by history and measuring tear pH with litmus paper OSteroids, pupil dilators. OVitamin C orally and topically to improve healing and delay ulceration
- 56. Chemical injury OAnticollagenases (e.g.:tetracycline) orally and topically to reduce risk of corneal melting by inhibiting matrix metalloproteinases. Olimbal stem cell transplantation Oin case of extensive damage of limbus preventing re- epithelialization of cornea and as a result melting of it (keratolysis) with time. Cells are taken either from the normal, fellow eye or from a donor source Ooverlay of amniotic membrane which protects and maintains the underlying tissue and promotes resurfacing.
- 59. This beautiful eyereflects the beauty of itās creater
Editor's Notes
- #32Ā Ā centre, the aperture of which can be varied by the circular sphincter and radial dilator muscles to control the amount of light entering the eye. Traumatic mydriasis paralysis of theĀ ciliary muscleĀ of the eye
- #33Ā traumatic aniridia Discovered after absorbtion of blood from AC
- #35Ā as an intraocular pressure (IOP) of 5 mm Hg or less. Low IOP can adversely impact the eye in many ways, including corneal decompensation, accelerated cataract formation, maculopathy, and discomfort
- #36Ā Vossiusā Ring iris epithelial cells leave pigment on the lens
- #47Ā Retinal dialysis: separation of retina from its junction with pars plana of ciliary body