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OCULAR TRAUMA
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Mechanical InjuriesClosed Globe InjuriesOpen Globe InjuriesContusionLamellar LacerationSuperficial foreign bodyLaceration Rupture Penetrating injuryPerforating InjuryIntraocular foreign bodyOCULAR TRAUMA CLASSIFICATION GROUP
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Concussion InjuryCoup or direct injuryContre-coup or distant damage
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CORNEAForeign body removed under topical anaesthesiaAbrasion patchingDescemet membrane rupture forceps deliveryBlood staining of cornea hyphaema with IOPReddish-brown or greenishSimulates anterior dislocation of clear lensDerivates of Hb in deep stromal corpusclesClears from periphery to centreUsually permanent
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SCLERAGlobe ruptureForce from inferotemporal directionNeighborhood of canal of SchlemmPosterior to insertion of rectiWound runs outwards and backwards concentric to limbus 3mm behindIris prolapse, hyphaema, retinal detachment, vitreous hemorrhageTreatment sutured with 8-0 ethicon with or without cryotherapy
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Iris and Ciliary bodyTraumatic iridocyclitis Traumatic miosisTraumatic mydriasisSphincter tearIridodialysis D shaped pupilUniocular diplopiaTraumatic aniridia or irideremia
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Iris and ciliary bodyAngle recession Rupture of anterior part of ciliary bodyTear between circular and longitudinal fibresHyphaema Late onset glaucomaTraumatic hyphaemaAsso with angle recession/iridodialysis/cyclodialysisIOP assesmentRe-bleedingLevel of hyphaema
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LensVossius ring iris imprint on anterior lens capsuleConcussion injury Mechanical damage to lens fibresCapsular tearPeripheral / Thinnest portionRosette shaped cataract Star shaped cortical sutures are delineatedFeathery lines of opacities radiate from themRapid intumescence of lens with secondary glaucomaDislocation Subluxation
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VitreousDetachment HemorrhageLiquefaction of vitreous
Choroid
Rupture concentric to disc usually temporal to itWhitish crescent with fine pigmentation at its marginChoroidal hemorrhageChoroidal detachment
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RetinaCommotio retinae (Berlins edema)Milky white cloudiness of posterior pole Cherry red spot at foveaRetinal hemorrhagesRetinal tearsRetinal detachmentTraumatic retinitis proliferansTraumatic macular degenerationMacular hole
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Chemical injuryAlkalis Lime WhitewashFresh mortarSurface epithelium necrosedPenetrates the corneaOccludes limbal vasculatureCorneal opacityMelting cataract Symblepharon
Acids Sulphuric acidHydrochloric acidNecrosis of conjSymblepharon Acids cause coagulation of proteins preventing deeper penetrationCorneal melting and opacity
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Chemical injurySeverity depends on strength and duration of contact
Grade I (mild) no limbal ischemiaGrade II (moderate) 180deg limbal ischemiaepithelial defect with hazy corneaGrade IV (severe) >270deg limbal ischemiaepithelial defect and hazy cornea
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Chemical injury - treatmentSaline wash for 30min or until pH is normalParticles of lime removed with forcepsTopical antibiotic dropsCycloplegicsTopical steroids reduces inflammationAcetazolamide tablet if IOP is raisedAscorbic acid oral and topicalGlass rod sweeping to prevent symblepharonBandage contact lens for epithelial healingLubricants
