Transcript Ocular Trauma - החוג הישראלי לרפואה

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
• Blunt
• Lacerating
• Chemical
Blunt Trauma
• Mild – moderate
– “Bruise” ocular tissues
– Eye wall intact
• Moderate – severe
– Rupture eye wall
– Very severe consequences
Lacerating Trauma
• “Cut” eye wall
• Outcome depends on extent and location
Location of Injury
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Anterior segment
Posterior segment
Adnexa
Orbital structures
Anterior Segment
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Conjunctiva
Cornea
Iris
Lens
Posterior Segment
• Vitreous
• Retina
• Optic nerve
Adnexa
• Eyelids
• Lacrimal Structures
Orbital Structures
• Extraocular muscles
• Bony walls
Disgusting Photographs
• Front to back…
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
Lid Laceration
Lacrimal Duct Laceration
• Repair ASAP
• Probing with silicon
tube and suturing
Conjunctival Trauma
• Sub conjunctival hemorrhage
– Self limiting
– No treatment needed
• Conjunctival laceration
– Make sure the sclera is intact
– Antibiotic ointment for 1-3 days
Subconjunctival Hemorrhage
External Foreign Body
• Can be in conjunctiva
or cornea
• Red painful and
watery eye
• Removal under slit
lamp
• Patching with antb
Corneal Foreign Body
Corneal Abrasion
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Severe pain and photophobia
Blurry vision
Erosion stains with fluresceine
Patching with antibiotic oint to
prevent infection and help reepithelization
• Healing 1-4 days
Corneal Abrasion
Chemical Burn
• Usually fat-cleaning
materials
• Pain, photophobia
• Treatment: irrigation,
irrigation, irrigation
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
• Iris can be captured in
the perforation wound
• Iris reposition if soon
after the injury and
corneal suturing
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
• Usually repaired in a
secondary operation
• If possible a plastic
intra-ocular lens is
inserted instead of the
damaged lens
• Treatment of
amblyopia crucial
Traumatic Cataract
Vitreous Hemorrhage
• Blood in vitreous
cavity
• Usually self limiting
• Can be cleared with
vitrectomy is rare
occasions
Retinal Hemorrhage
Optic Disc Hemorrhage
Intra-ocular Foreign Body
• Ocular emergency
• Removal in vitrectomy
• Retained FB can cause
infection or retinal
degeneration
Orbital Wall Fracture
• Problematic only if:
– Limitation of eye
ductions
– Disfiguring
enophthalmos
Traumatic Optic Neuropathy
• Optic nerve injured in
optic canal
• Usually vision loss
• No good treatment
• Mega-dose steroids?
Common Minor Eye Injuries
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Corneal abrasion
Corneal foreign body
Chemical splash
Traumatic iritis
Diagnosis
• History
– Sharp vs blunt vs chemical injury
• Exam
– CHECK VISION
– CHECK VISION
– CHECK VISION
Diagnosis cont.
• Exam – open lids apart!
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Cornea clear?
Pupil round?
Pupil black?
Blood clotted behind cornea?
Diagnosis cont.
• Exam
– Red reflex?
– Eyes move symmetrically?
Fluorescein Test
• Topical “eye dye”
• COBALT light
Corneal Abrasion
Abrasion Treatment
• Antibiotic ointment
• +/- patch
• 1-2 day follow-up with eye doc
Corneal Foreign Body
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
• 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
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Moderate blunt injury
Photophobia
Lid bruising/edema
Subconjunctival
hemorrhage or
injection
• Pupil sluggish
• Evaluation by eye doc
Please Do Not Confuse
• Subconjunctival hemorrhage
• Hyphema