Ocular Trauma

Orbital Architecture
Nature of Injury
Blunt
Lacerating
Chemical
Blunt Trauma
Mild moderate
bruise ocular tissues
Eye wall intact
Moderate severe
Rupture eye wall
Very severe consequences
Location of Injury
Adnexa
Anterior Segment
Posterior Segment
Orbital Structures
Adnexa
Eyelids
Lacrimal Structures
Racoon Eye
Lid Laceration
Anterior Segment
Conjunctiva
Cornea
Iris
Lens
Posterior Segment
Vitreous
Retina
Optic nerve
Orbital Structures
Extraocular muscles
Bony walls
Common Minor Eye Injuries
Corneal abrasion
Corneal foreign body
Traumatic iritis
Corneal Abrasions
Corneal Abrasions
Corneal Abrasions - Management
To patch or not to patch, that is the question.
Flynn et al: J. Family Practice. 1998.
Le Sage N et al:Ann of EM. 2001.
Contact lens wearer
Non-contact lens wearer
Topical anesthetics
Ophthalmology consult?
Follow- up: 48 hrs

Corneal Foreign Body
Subconjunctival Hemorrhages
Definition
Symptoms
Signs
Complete exam
Treatment

Subconjunctival Hemorrhage
Iritis- Presentation
Definition
Symptoms
Photophobia
Eye pain
Signs
Limbus injection
Miosis
Mydriasis
VA


Anterior Chamber Reaction
Hypopyon
Iritis Management
Complete Examination.
Cycloplegic
Sunglasses
No antibiotics
Topical steroids?
Follow-Up
Hyphema- Presentation
Definition
Symptoms
Grading
0 RBCs
I <1/3
II 1/3 1/2
III > 1/2
IV eight ball
Hyphema- Management
Ophthalmic consult
Pupillary play/Eye Patch
IOP control > 30 mmHg (>24 mmHg in HbSS)
Admission
Complications
Re-bleed
Post-traumatic glaucoma


Lens subluxation
and dislocation
Definition
Disposition
Subluxed
Dislocated
Post-traumatic Cataract


Retinal Detachment /Vitreous Hemorrhage
Definition

Symptoms
Photopsia
Image distortion
Painless
Floaters
Floaters with flashing light
Defects in VA



Vitreous Hemorrhage
VA/Red reflex/RAPD
Fundoscopy
Ophthalmology consult
Disposition


Retinal Detachment
RAPD/VA
Fundoscopy
Ophthalmology consult
Disposition

Retrobulbar Hemorrhage - Presentation
Definition
Symptoms
Critical signs
Proptosis
Visual acuity
Marcus-Gunn pupil
Red desaturation


Retrobulbar Hemorrhage-
Management
Progressive
Lateral canthotomy
CT scan of orbit
Disposition


Lacerating Trauma
cut eye wall
Outcome depends on extent and location
Ruptured Globe
Presentation
Incidence
1.1-3.5%
Symptoms
Predictive signs
1) VA showing light
perception or worse.
2) Abnormal deep/shallow
anterior chamber.
3) Opacity preventing view
of fundus.
4) IOP of 5 or less.
Ruptured Globe - Management
Diagnosis Suspected STOP Examination
Do NOT put pressure on globe
Antibiotics
Tetanus
CT scan
Prepare for surgery.

Corneal Laceration