Ocular Trauma

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 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
• Anterior segment
• Posterior segment
• Adnexa
• Orbital structures
 Anterior Segment
• 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
• 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
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
• 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!
– 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
• Moderate blunt injury
• Photophobia
• Lid bruising/edema
• Subconjunctival
hemorrhage or
injection
• Pupil sluggish
• Evaluation by eye doc
 Please Do Not Confuse
• Subconjunctival hemorrhage
• Hyphema