OCULAR INJURIES An introduction & nomenclature

22.11.2013

Ayesha S Abdullah

Learning outcomes

By the end of this lecture the students would be able to  Describe the epidemiology of ocular injuries  Classify globe injuries according to the Birmingham Eye Trauma Terminology (BETT) system of classification  Differentiate between OGI and CGI

How common is it?

 Trauma is the commonest cause of ocular emergencies reported in trauma centres  A total of 1.6 million cases of blindness are caused by eye injures  Some 2.3 million cases with low vision are due to ocular injuries  Some 19 million cases of mono ocular blindness are due to eye injuries

Risk factors

 Gender , any guess?

 3:1 male to female ratio  Rural areas  Compromised socioeconomic status  Illiteracy  Conflicts

Classification

 According to vector (The Agent)  According to settings (Place of injury)  According to pathology (Effects produced)  According to anatomical structures involved  According to severity (Damage produced)

According to the site involved

 Orbital trauma  Superficial & corneal foreign bodies  Lid injuries  Globe injuries

Nature of injurious agent



Mechanical Injuries



Chemical Injuries

Acid Alkali Others 

Radiation Injuries



Thermal Injuries



Electrical Injuries

Place of Injury

       

Home School Playground Agriculture Industry Laboratory Workshops Assault/ combat

Birmingham Eye Trauma Terminology System (BETTS)

http://www.asotonline.org/bett.html

Definitions -BETTS

      Closed Injury in which cornea & sclera are intact but there is intraocular damage.

Open Injury is associated with full-thickness wound of cornea or sclera or both.

Rupture is a full-thickness wound caused by blunt trauma Laceration is full-thickness injury caused by a sharp object Penetration is caused by a single laceration with a sharp object Perforation consists of two lacerations, one entry and one exit http://www.asotonline.org/bett.html

http://bestpractice.bmj.com/best-practice/monograph/961/basics/classification.html

Orbital trauma

 Blow out floor fracture, medial wall, floor, roof  Contusion injury  Lacerations  Orbital haematoma

Eye Lids

 Contusion  Hematoma  Lacerations

Beware of the blood loss especially in children

Late Complications

Effects of close globe injury (CGI)

 Mechanism  AP compression  Expansion in the equatorial plan  Transient & excessive increase in IOP  Impact is primarily absorbed by ??

 Lens –Iris diaphragm & vitreous   The damage can happen in any tissue commonly has long-term effects/ sequelae

Close Globe Injuries

         Subconjunctival Haemorrhage Corneal abrasion Acute corneal oedema Traumatic iritis Traumatic Mydriasis / Miosis Hyphaema Iridodialysis Cyclodialysis / Angle recession Ciliary shock

Close Globe Injuries

        Subluxation and dislocation of lens Cataract Posterior vitreous detachemet Vitreous haemorrhage Choroidal rupture Commotio retinae Retinal Breaks    Dialysis Equatorial tears Macular holes Optic nerve avulsion

Home work

List three recommendations for the following  Primary  Secondary  Tertiary prevention of ocular trauma Three power point slides with three points on each slide send at [email protected] with your name and role number