Eye Trauma Edited

8/8/2019 Eye Trauma Edited

1/68

Eye trauma: Penetrating and

blunt

Eye trauma: Penetrating and

bluntAdapted from source

8/8/2019 Eye Trauma Edited

2/68

Anatomy

8/8/2019 Eye Trauma Edited

3/68

Blunt eye injuries

contusions

subconjunctival haemorrhages

corneal foreign bodies &

abrasions

hyphaema

burns

blow-out fractures

retrobulbar haemorrhages

other

8/8/2019 Eye Trauma Edited

4/68

8/8/2019 Eye Trauma Edited

5/68

Sport classification and risk

Collisionfootball, rugby, hockey

Contactwrestling

Non-contacttrack, tennis, rowing, swimming, x-country running

Otherbowls, golf, archery, field events

8/8/2019 Eye Trauma Edited

6/68

Risk cont

Low risk

= no use of ball, bat, puck, stick, racquet AND nobody contact

track, field, swimming, gymnastics, cycling High risk

baseball, raquet sports, golf, water polo, fencing

Very high riskboxing, wrestling, contact martial arts

8/8/2019 Eye Trauma Edited

7/68

8/8/2019 Eye Trauma Edited

8/68

The big five for red eye:

1. subconjunctival haemorrhage2. corneal foreign bodies

3. corneal abrasions

4. hyphaema

5. uveitis

The big five for red eye:

1. subconjunctival haemorrhage2. corneal foreign bodies

3. corneal abrasions

4. hyphaema

5. uveitis

8/8/2019 Eye Trauma Edited

9/68

Sub Galeal Haematoma

8/8/2019 Eye Trauma Edited

10/68

chemosis

8/8/2019 Eye Trauma Edited

11/68

subconjunctival haemorrhage

8/8/2019 Eye Trauma Edited

12/68

8/8/2019 Eye Trauma Edited

13/68

cornealforeign body

8/8/2019 Eye Trauma Edited

14/68

8/8/2019 Eye Trauma Edited

15/68

8/8/2019 Eye Trauma Edited

16/68

8/8/2019 Eye Trauma Edited

17/68

8/8/2019 Eye Trauma Edited

18/68

8/8/2019 Eye Trauma Edited

19/68

fluorescein

8/8/2019 Eye Trauma Edited

20/68

WARNING !WARNING !

TTOTTO

topical

anaesthetics

XX

8/8/2019 Eye Trauma Edited

21/68

Chemical burns

8/8/2019 Eye Trauma Edited

22/68

8/8/2019 Eye Trauma Edited

23/68

Assault

8/8/2019 Eye Trauma Edited

24/68

periorbital haematoma

8/8/2019 Eye Trauma Edited

25/68

proptosis

8/8/2019 Eye Trauma Edited

26/68

8/8/2019 Eye Trauma Edited

27/68

retrobulbar haemorrhage

8/8/2019 Eye Trauma Edited

28/68

surgical empyhsema

8/8/2019 Eye Trauma Edited

29/68

Blowout fractures

8/8/2019 Eye Trauma Edited

30/68

8/8/2019 Eye Trauma Edited

31/68

8/8/2019 Eye Trauma Edited

32/68

8/8/2019 Eye Trauma Edited

33/68

8/8/2019 Eye Trauma Edited

34/68

8/8/2019 Eye Trauma Edited

35/68

hyphaema

8/8/2019 Eye Trauma Edited

36/68

uveitisposterior synechiae

8/8/2019 Eye Trauma Edited

37/68

DilateDilate

8/8/2019 Eye Trauma Edited

38/68

iridodialysis

8/8/2019 Eye Trauma Edited

39/68

8/8/2019 Eye Trauma Edited

40/68

avulsed optic nerve

8/8/2019 Eye Trauma Edited

41/68

optic atrophymacular hole

8/8/2019 Eye Trauma Edited

42/68

commotio retinae

8/8/2019 Eye Trauma Edited

43/68

8/8/2019 Eye Trauma Edited

44/68

choroidal tear

8/8/2019 Eye Trauma Edited

45/68

What are signs/symptoms of

trauma that would requireimmediate referral?

8/8/2019 Eye Trauma Edited

46/68

What are signs/symptoms of trauma that

would require immediate referral?

Loss of vision or visual field

Diplopia /Proptosis of the eye

Light flashes or floaters Irregularlyshaped pupil

Red/inflamed eye /FBsensation/embedded foreign body

Hyphema (blood in anterior chamber)

Halos around lights (corneal edema)

Laceration of the lid margin ornear medial canthus

Broken contact lens orshattered eyeglasses glassin eye

Suspected globe perforation

8/8/2019 Eye Trauma Edited

47/68

Trauma: Blunt or penetrating?

Structuresinvolved

Examination of eye

Penetrating ? IOFB When to refer

8/8/2019 Eye Trauma Edited

48/68

3-DAnatomy

8/8/2019 Eye Trauma Edited

49/68

Penetrating wounds: Historyhelpful

8/8/2019 Eye Trauma Edited

50/68

IOFB

8/8/2019 Eye Trauma Edited

51/68

Subconjunctival haemorrhages

8/8/2019 Eye Trauma Edited

52/68

Penetrating

8/8/2019 Eye Trauma Edited

53/68

8/8/2019 Eye Trauma Edited

54/68

8/8/2019 Eye Trauma Edited

55/68

Lidmargin laceration

8/8/2019 Eye Trauma Edited

56/68

Lidmargin lacerationCarefullyalignto preventnotching

Closetarsal plate withfineabsorbablesuture

Place additional marginal

silksutures

Closeskin withmultiple

interrupted 6-0 blacksilksutures

Align with 6-0 blacksilk

suture

8/8/2019 Eye Trauma Edited

57/68

Canalicular laceration

Repair within 24 hours Locateandapproximateendsoflacerati

Bridgedefect withsiliconetubing

Leavein situ forabout 3 months

8/8/2019 Eye Trauma Edited

58/68

Points on the eyelids

Refer if lid edge isinvolved Ophthalmic or

Plastics

Orbicularis oculi muscle issupplied by the VIIth

cranial nerve and closes the eye

The levator muscle opens the lid (IIIrd nerve)

Blink reflex

Afferent is often Vthnerve

Efferent is VIIth nerve

8/8/2019 Eye Trauma Edited

59/68

8/8/2019 Eye Trauma Edited

60/68

The anterior chamber

May contain blood (hyphaema) after trauma

May contain pus (hypopyon) in infections of the eye

8/8/2019 Eye Trauma Edited

61/68

Checking for penetratinginjury

What are important

clues to penetration of

the eye?

8/8/2019 Eye Trauma Edited

62/68

Checking for penetratinginjury

Soft eye

Visual acuity

Red reflex absent

8/8/2019 Eye Trauma Edited

63/68

Corneal and scleral lacerations

8/8/2019 Eye Trauma Edited

64/68

Managementofintraocularforeignbodies

Localization withreferencetoradio-opaquemarker

X ray

CT Scan

B-scan Ultrasound

8/8/2019 Eye Trauma Edited

65/68

Removing IOFBs

Old Electro-magnet

Modern Forceps

and vitrectomy

Complications of penetrating trauma

8/8/2019 Eye Trauma Edited

66/68

Complicationsofpenetratingtrauma

Flatanteriorchamber

Vitreoushaemorrhage

Damageto lensandiris

EndophthalmitisTractional ret

inal

detachment

Uveal prolapse

8/8/2019 Eye Trauma Edited

67/68

Endophthalmitis

8/8/2019 Eye Trauma Edited

68/68

Endophthalmitis

Replicating organismsinside the

eyeball

Often: Staphylococci,Bacillus or

Gram negative bacteria

Pain, red eye,hypopyon, loss of vision

and red reflex