Transcript Traumatologie oka - MUDr. Břetislav Brožek, CSc.

Eye Traumatology
MUDr. Břetislav Brožek, CSc.
www.brozek.cz
•
Structure of lecture
•In accordance mechanism and type of
injury
•In accordance with part of eye orgánu
• most often clinical injury
Mechanism of accident
• In accordance with activity: industrial,
trafic, child
• In accordance with nature: mechanical,
radiation, heat, chemical, combined
Occupational Injury
• perfect record,
relationship worker/employer
• record about protective tools
• protect the pacient and also yourself
Trafic and sports injuries
• mostly significant and combined
• mostly you´ll examine in other department
• watch eye motility problem – brain injury
Child injury
• always serius, watch inproper care of adults
• very often incorrect or untrue anamnestic
data
• often hidden perforative injury
• watch battered children
Specific child´s eye injuries
• Prenatal injury – during amniocenthesis
• obstetric forceps: tears of Desc.membr.
hemoragies on eye fundus
edema and bleeding to lids
• must to notify
Structure due nature
• mechanical: cutting, lacerated, blunt, combined
• radiation: UV, sun, IR
• heat
• chemical
mechanické
• cutting, stub: nives, sticks, scissors, limb, wires,
flying bodies …..
• lacerated: larger tools, teeth of animals
• contusion: balls, hockey-stick, cornu of animal,
elbows, knees
• combined
• foreign bodies inside od eye and orbit
•
radiation
• UV : sun, snow blindness, sea, ozone hole
welders.
• sun: do not look to the sun during
eclipse of the sun
• IR záření – sklářská katarakta, hoblinky
• lasers (different danger accord. power)
• ionizing – like snow blindness, cataract
oftalmia fotoelectrica
oftalmia fotoelectrica
• welding, UV rays in mountains
• damage of epithelium cells
• start of pain 4-6 hours after welding
welder is coming at one hour at night….
• atb a epitheliz. Ointm,
heat
• everything, even cigarettes
• mostly lids, burned lashes
• cornea – boiled egg white
• oedema, erythema, pain, blisters, necrosis,
coaling
• sterile cover, atb ointm., burns unit,
• scarring, lagoftalmus, closed lacrimal ways
•
chemical
• serious: at work, military, industry
• home: cleaning chemicals
• street: tear gas
• LIME white lime, whitewash
• wash and wash, eversion of lids
• careful medical record,
• you see: hyperaemia, oedéma of conj., abrasion
of cornea white stroma, iritis.
therapy: atb ointm., mydriatics, artef.tears, steroids
only eye doc., , transplantation of cornea
ischemia of limbus and conjunctiva
cloudy cornea
strong cloudy cornea
complete opaque cornea
poškození okolí oka a předního segmentu oka slzným
plynem
poleptání oka a jeho okolí alkálií
perforovaný vřed rohovky
zalepený cyanoakrylátovým lepidlem
povrchní vazkularizace rohovky po poleptání
Injury of conj. and cornea:
• conj. abrasion - pain, ointm.
• corneal abrasion: strong pain, atb ointm.,
carefull controls, pressure dressing,
recidiv.abrasion, Cont.lens,
• forign bodies: under the lids, in a cornea
• must be extracted, strong pain, controls
• atb ointm., possible iritis
•
corneal foriegn body
eroze rohovky – etiologie nejrůznější
•
•
•
•
glue
•
flyblow
flyblow
perforating injury of sclera
•
•
•
•
•
•
•
often with cornea
always with coinjuntiva
always injury of retina
often with foriegn body
always very serious,
always urgent surgery
perforating injury
• always serious
• gravity of consequences accord. deepness of
injury
• foriegn body
• with prolaps of tissue or without
• blunt injury = rupture of globe
peaked pupil
řezná rány skléry s prolapsem iris
řezná rány skléry s prolapsem
sklivce
extrémní ruptura bulbu
lehčí ruptura bulbu
řezná rána rohovky a čočky
immediate treatment and surgery
• specialised hospital and eye clinic
• watch hidden ruptures and perforations
• risk of sympathetic ophthalmy
intraocular foriegn body
•
•
•
•
•
metallic x nonmetallic (CT?, NMR)
magnetic x nonmagnetic
ant. segment x posterior segment
very urgent, admition, surgery
only specialized clinics
nitrooční těleso
v komorovém úhlu
preretinální nitrooční
kovové těleso s
preretinální hemoragií
•
eye contusion
• often serious,
• damage of many tissues:
• cornea: abrasion, edéma
• ant.ch: hyphema
• iris: iridorexis (tear of margin), iridodialysis
(break of root)
• dislocation of lens and cataract
• contusion of retina, breaks of retina and choroid
• total rupture of globe
•
iridodirhexis – trhliny zornicového okraje
iridodialysis
•
traumatic dislocation of
lens temporally down
in posterior chamber
luxation of lens into the
anterioe chamber after
blunt trauma
central retina hole after
trauma
avulsion of optic nerve
čerstvá ruptura sítníce
stará ruptura sítnice
blow-out fracture
• direct stroke to eye – spreading of pressure in
orbit
• fracture of wall of orbit, mainly floor
• incarceration a prolaps of tissue to fracture
• enoftalmus, vertic. motility problem
• diplopie, mainly vertical
•
Always pefect medical records !
• you must guard youself
• lawyers do not sleep
•
Never forget !
• irrigation of lacrimal ways as soon as possible
• it is not so simple
• no squint is normal – NEVER !
• remember possible intraocular tumor
• immediate eye examination
• lazy eye blindness you cannot educate
after 4-5 years
Thank You for you
attention
The best students can became
eye microsurgeons