Professional Documents
Culture Documents
important to examine
globe for associated
injuries
Case: 17 y/o male punched on the right periorbital
area, upon ocular examination he is noted to have
restriction of upward gaze…what would you
suspect?
consider an orbital floor fracture
Orbital Floor Fracture
blunt trauma
subcutaneous emphysema
I <1/3
II 1/31/2
III 1/2 near total
IV blood completely fills AC
Secondary glaucoma
blood in anterior chamber is not necessarily
harmful, however large quantities may clog the
trabecular meshwork resulting in an increased
intraocular pressure.
Complications
Optic atrophy
Irreversible optic nerve damage due to
increased intraocular pressure
Corneal staining
Management
Surgical decompression
Conjunctival Laceration
(With Subconjunctival Hemorrhage)
Signs/ Symptoms :
slight eye pain
slight redness
foreign body sensation
subconjunctival hemorrhage
conjunctival lacerations heal
spontaneously, no need for surgical repair
prophylactic antibiotic eye ointment
It is very important to rule out associated
injury to the sclera, specially in cases of
full thickness conjunctival lacerations.
Case: 27 y/o female apparently hit by her baby’s
finger, complaining of eye pain, tearing, upon
examination you note a corneal epithelial defect…
impression?
Corneal Abrasion
Defect in the corneal
epithelium
Flourescein Staining
s/sx :
foreign body sensation
tearing
eye redness
hx of scratching or being hit by a
fingernail or paper edge
may have slight eyelid swelling
Corneal abrasions usually re-epithelialize within 24-48
hours
Management
eyelid eversion to
check for additional
foreign bodies
Open Globe Injuries
Full thickness scleral and/or corneal
lacerations
Perforating type of injuries
Considered as ocular emergencies
full thickness scleral laceration
scleral laceration
full thickness scleral laceration :
Pain,
visual acuity
Irregular pupil
secondary to iris
prolapse
Shallow or flat
anterior chamber (due
to aqueous leakage)
Treatment :
Surgical repair as soon as possible
Chemical Injuries
Acid burns – (ex. exploded car batteries)
coagulation necrosis
usually confined to surface tissues
Ointments
- provide a longer contact time
- may temporarily induce blurring
- slow onset
- avoids systemic toxicity
Classification
(1) Anti-infectives
antibiotics, antivirals & antifungals
antibiotics may also be given as
prophylaxis prior to or after any ocular
surgery
(2) Anti-inflammatory drugs
(a) Topical
provide anesthesia to conjunctiva, cornea & ant. sclera
non-invasive, short duration - suitable for short
procedures
do not provide anesthesia to eyelids, intraocular
structures & EOM
(b) Intraocular
most commonly used is 1% preservative free lidocaine
usually given as adjunct to topical anesthetics so that
ant. segment structures are also anesthesized
(c) Orbital
administered via injection around or behind the globe
longer duration, suitable for lengthy procedures
provide full anesthesia to eye and extraocular stuctures
such as the eyelids & EOMs
may inadvertently cause hemorrhage, scleral perforation
or optic nerve trauma
(4) Anti-glaucoma
Beta blocker
lowers IOP by aqueous production
ex: timolol, betaxolol
Prostaglandin analogue
lowers IOP by uveoscleral outflow
ex: latanoprost
Hyperosmotic agent
lowers IOP by drawing fluid from the eye to the intravascular space
ex: mannitol
Cholinergic agonist
lowers IOP by aqueous humor outflow; also induces miosis
ex : pilocarpine
(5) Mydriatics, Cycloplegics & Miotics
Cyclosporine
increases tear production in severe dry eyes
(keratoconjunctivitis sicca) in which deficiency of
tears may have been suppressed due to chronic
ocular irritation
(7) Botolinum toxin
Blocks acetylcholine release inducing
muscle paralysis.
Used to control disturbing
blepharospasms and hemifacial spasms.
Thank You