PENETRA TING EYE INJURIES LT COL QAMAR UL ISLAM CLASSIFIED EYE SPEC / ASST PROF AFIO, RAWALPINDI.

PENETRAPENETRATING EYE TING EYE INJURIESINJURIES

LT COLLT COLQAMAR UL ISLAMQAMAR UL ISLAMCLASSIFIED EYE SPEC / ASST CLASSIFIED EYE SPEC / ASST PROFPROFAFIO , RAWALPINDIAFIO , RAWALPINDI

EPIDEMEOLOGYEPIDEMEOLOGY

• Ocular trauma is the leading cause of monocular blindness in people < 40 yrs of age

• Accounts for approx 50% of all ocular emergencies

• More common in males (78 - 84%)

• Usually occur at workplace

(outdoor location)

IMPACT OF OCULAR INJURYIMPACT OF OCULAR INJURY

• Physical disability

• Social dependency

• Financial implications

OCULARTRAUMA

MECHANICAL

CHEMICALTHERMAL

RADIATION

TYPES OF OCULAR INJURIESTYPES OF OCULAR INJURIES

Mechanical Ocular TraumaMechanical Ocular Trauma

Closed Globe Open Globe

ContusionLamellar

LacerationLaceration

Penetrating Perforating

Rupture

TERMINOLOGIES

CLOSED GLOBE INJURY

• Blunt trauma

• Corneoscleral wall intact

• Intraocular damage

OPEN GLOBE INJURY

• Full thickness wound

of the corneoscleral wall

CONTUSION

• Closed injury resulting from

blunt trauma

• Damage at site of impact or at

a distant site

LAMELLAR LACERATION

• Partial thickness wound

caused by sharp object

CLOSED GLOBE INJURY

RUPTURE

• Full thickness wound caused

by blunt trauma

• Globe gives way at the

weakest point

LACERATION

• Full thickness wound caused

by sharp object

• At the site of impact

OPEN GLOBE INJURY

(inside to outside) (outside to inside)

PENETRATION

• Single full thickness wound

without an exit wound

• Retained intraocular foreign

body

PERFORATION

• Two full thickness wounds

• Entry and exit

OPEN GLOBE INJURY

PENETRATING/PERFORATING OCULAR TRAUMAPENETRATING/PERFORATING OCULAR TRAUMA

• CAUSES : Assault, domestic accident (sharp obj like pen, pencil, scissors, knives, broken spectacles) disposable syringes, sport injuries, windshields of cars in RTA, mine/missile blast injuries, fire arm injuries, chopping or cutting wood, hammering metals or nails

PENETRATING/PERFORATING OCULAR TRAUMAPENETRATING/PERFORATING OCULAR TRAUMA

• MECH OF INJURY :Size of objectSpeed at the time of impactComposition of object

o SHARP OBJECT well defined laceration of globe

o FLYING F.B damage related to their kinetic energy

o RETAINED IOFB

• MECHANICAL EFFECTS• INTRODUCTION OF INFECTION

• TOXIC/CHEMICAL EFECTS

MMain ain SSymptomsymptoms/Signs/Signs• Redness of eye,

• Haemorrages

• Congestion

• Lacrimation

• Photophobia

• Raised Eyelids

• Itchy/Watery Eyes

• Blurring or Loss of Vision

• Change in Pupil Shape

• Blood or Fluid Leakage from the Eye

• Foreign Object Penetrating Eye

EEffects Of Penetrating Ocular Injuriesffects Of Penetrating Ocular Injuries

• Mechanical effects: Laceration of the conjunctiva, corneal lacerations,Vitreous haemorrage, rupture of globe, retinal tears and detachments, scarring which leads to cataract and glaucoma. And Intra ocular foriegn bodies.

• Introduction of infection: the entrance of the wound may serve as a route of entry for pyogenic bacteria,which may lead to the fromation of abscess of cornea, purulent iridocyclitis or Endophthalmitis

• Sympathetic Ophthalmitis: It is a complication of penetrating injury.

• Visual impairment and Enucleation

EEffects Of Penetrating Ocular Injuriesffects Of Penetrating Ocular Injuries

EEffects Of Penetrating Ocular Injuriesffects Of Penetrating Ocular Injuries

* In general always suspect more extensive

injury than may be readily apparent and

search carefully for any defects in the

integrity of the globe or intraocular foreign

bodies

MANAGEMENT GUIDELINESMANAGEMENT GUIDELINES

Medical Reception Centre Make the patient comfortable

Take vital signs

Assess the degree of damage

Take Visual Acuity

Torch examination

Distant Direct Ophthalmoscopy

Documentation

MANAGEMENT GUIDELINESMANAGEMENT GUIDELINES

GENERAL PRINCIPLES

• Determine the nature and extent of any life-threatening problems

• History – circumstances, timing, likely object

• Ocular examination (minimal handling)

» Eyes

» Orbits

• Application of eye pad

• Psychological (avoid negative reassurance !!!!!!!)

• Referral to eye specialist

MANAGEMENT GUIDELINESMANAGEMENT GUIDELINES

Ultrasonography

X- Ray Orbit

CT SCAN

MANAGEMENT GUIDELINESMANAGEMENT GUIDELINES

INVESTIGATIONSINVESTIGATIONS

PRINCIPLES OF SURGICAL REPAIR

• PRIMARY REPAIR» Undertaken immediately

» Preserve visual acuity

» Remove the dead and devitalized tissue

» Preserve as much normal tissue as possible

» Close any open wounds

» Prevent / treat any nidus of infection

• SECONDARY REPAIR» 10 – 14 days after primary repair

» Clear opacities of the media

» Stabilize abnormal vitreoretinal interactions

MANAGEMENT GUIDELINESMANAGEMENT GUIDELINES

• Prophylaxis of Endophthalmitis

Antibiotics

• Enucleation

(when nothing to salvage)

MANAGEMENT GUIDELINESMANAGEMENT GUIDELINES

• REMOVAL OF IOFB TECHNIQUE OF REMOVAL OF IOFB depends on :

o Chemical compositiono Locationo Size of IOFBo Clarity of mediao Phakic statuso Toxicity of IOFB

MAGNET removalFORCEPS removal

MANAGEMENT GUIDELINESMANAGEMENT GUIDELINES

Don’ts and Do’s• DO NOT flush the eye with any liquids other than saline or warm water or

even better just do not touch the eye

• DO NOT remove the object out of the eye

• DO NOT put any pressure on the eye• Do NOT rub your eye.• Reassure the person and advise against rubbing or moving their eye

as this can cause further damage• If the injury is severe, place a moist pad and loosely bandage the

eye.• Transport the patient to the nearest Hospital as fast as possible• In the case of small penetrating objects, use a cup to cover the object

and keep the person calm and lying down until help arrives.

MANAGEMENT GUIDELINESMANAGEMENT GUIDELINES

TAKE HOME MESSAGETAKE HOME MESSAGE

Anticipation of complications requiring referral

to ophthalmic surgeon

The nature and possible consequences of the

patient’s condition should be communicated to

the patient and his family as accurately and

honestly as possible

Never trivialize a condition since untoward

complications can make for a very dissatisfied

patient and a vulnerable physician

T h a n k y o

u

IMPACT OF OCULAR INJURYIMPACT OF OCULAR INJURY