Ocular Trauma

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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

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Nature of Injury

• Blunt
• Lacerating
• Chemical

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Blunt Trauma

• Mild moderate
• Bruise ocular tissues
• Eye wall intact
• Moderate severe
• Rupture eye wall
• Very severe consequences

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Lacerating Trauma

• Cut eye wall
• Outcome depends on extent and location

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Location of Injury

• Anterior segment
• Posterior segment
• Adnexa
• Orbital structures

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Anterior Segment

• Conjunctiva
• Cornea
• Iris
• Lens

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Posterior Segment

• Vitreous
• Retina
• Optic nerve

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Adnexa

• Eyelids
• Lacrimal Structures

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Orbital Structures

• Extraocular muscles
• Bony walls

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Disgusting Photographs

• Front to back

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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

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Lid Laceration
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Lacrimal Duct Laceration

• Repair ASAP
• Probing with silicon tube and suturing

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Conjunctival Trauma

• Sub conjunctival hemorrhage
• Self limiting
• No treatment needed
• Conjunctival laceration
• Make sure the sclera is intact
• Antibiotic ointment for 1-3 days

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Subconjunctival Hemorrhage
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External Foreign Body

• Can be in conjunctiva or cornea
• Red painful and watery eye
• Removal under slit lamp
• Patching with antb

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Corneal Foreign Body
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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

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Corneal Abrasion
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Chemical Burn

• Usually fat-cleaning materials
• Pain, photophobia
• Treatment irrigation, irrigation, irrigation

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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

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Corneal Perforation -Cont

• Iris can be captured in the perforation wound
• Iris reposition if soon after the injury and
  corneal suturing

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Hyphema

• Blood in anterior chamber
• Sometimes hard to diagnose
• Blurry vision and pain
• Self limiting
• Complications elevation of intra-ocular pressure
  and re-bleeding

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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

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Traumatic Cataract
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Vitreous Hemorrhage

• Blood in vitreous cavity
• Usually self limiting
• Can be cleared with vitrectomy is rare occasions

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Retinal Hemorrhage
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Optic Disc Hemorrhage
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Intra-ocular Foreign Body

• Ocular emergency
• Removal in vitrectomy
• Retained FB can cause infection or retinal
  degeneration

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Orbital Wall Fracture

• Problematic only if
• Limitation of eye ductions
• Disfiguring enophthalmos

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Traumatic Optic Neuropathy

• Optic nerve injured in optic canal
• Usually vision loss
• No good treatment
• Mega-dose steroids?

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Common Minor Eye Injuries

• Corneal abrasion
• Corneal foreign body
• Chemical splash
• Traumatic iritis

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Diagnosis

• History
• Sharp vs blunt vs chemical injury
• Exam
• CHECK VISION
• CHECK VISION
• CHECK VISION

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Diagnosis cont.

• Exam open lids apart!
• Cornea clear?
• Pupil round?
• Pupil black?
• Blood clotted behind cornea?

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Diagnosis cont.

• Exam
• Red reflex?
• Eyes move symmetrically?

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Fluorescein Test

• Topical eye dye
• COBALT light

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Corneal Abrasion
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Abrasion Treatment

• Antibiotic ointment
• /- patch
• 1-2 day follow-up with eye doc

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Corneal Foreign Body
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Foreign Body Treatment

• Anesthetize eye
• Remove FB
• Cotton swab (dont worsen abrasion!)
• Kimura spatula
• /- needle tip
• Antibiotic oint /- patch
• 1-2 day follow-up with eye doc

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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

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Traumatic Iritis

• Moderate blunt injury
• Photophobia
• Lid bruising/edema
• Subconjunctival hemorrhage or injection
• Pupil sluggish
• Evaluation by eye doc

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Please Do Not Confuse

• Subconjunctival hemorrhage
• Hyphema