Ocular trauma. Outline ocular trauma Ⅰ. mechanical factors Ⅱ. physical factors Ⅲ. chemical...
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Transcript of Ocular trauma. Outline ocular trauma Ⅰ. mechanical factors Ⅱ. physical factors Ⅲ. chemical...
Ocular trauma
Outline
ocular trauma
Ⅰ. mechanical factors
Ⅱ.physical factors Ⅲ.chemical factors
Classification
• Causative factors of injury
– Mechanical ocular trauma
– Non-mechanical ocular trauma
• Degree of injury
– Microtrauma
– Moderate injury
– Macrotrauma
Outline New classification• Ocular trauma
Close Open
Contusion
Laminar laceration
Rupture
Penetration
Foreign body
Penetration-through
Laceration
Examination
• Examination of ocular trauma
– History
– General condition
– Visual acuity
– Extra-eye examination
– eyeball examination
– Assist examination
Treatment
• Treatment
– to rescue life
– chemical injury —— to rinse with mass
of water
– Open injury—— TAT
– Penetration injury—— to avoid pressure
– Reasonable antibiotics
Ocular contusion
• Ocular contusion : caused by mechanical blunt
force
• > 1/3 ocular trauma
• Causative factors of injury
– Blunt body
– High-pressure gas / fluid
– Blunt force conduction —— indirect injury
Ocular contusion
§ Corneal Bruise§ Iris and Ciliary Body Bruise Iris injury and pupil abnormityIris injury and pupil abnormity Hyphema§ Lens Bruise§ Vitreous hemorrhage§ Choroid Bruise§ Retinal Commotion and Bruise
Corneal Bruise
• Clinical manifestation and treatment
– Superficial lamella abrasion —— antibiotic
ointment + eyepatch and to avoid topical
anaesthesia
– Corneal stroma injury—— glucocorticoid ,
mydriasis when necessary
– Corneal rupture —— suture
Corneal Bruise
Iris and Ciliary Body Bruise
• Trauma Trauma iridocyclitis• Clinical manifestationClinical manifestation
– diminution of vision ,, irritation– ciliary congestion– Iris edema, Iris edema, blurred texture– Tyndall’s signTyndall’s sign– KPKP
• Treatment Treatment – Glucocorticoid // NSAID– Mydriatic
Iris and Ciliary Body Bruise
Iris and Ciliary Body Bruise
Iris injury and pupil abnormityIris injury and pupil abnormity
Iris and Ciliary Body Bruise
clinical manifestationclinical manifestationHyphema
Iris and Ciliary Body BruiseHyphema
• Treatment
– Semi-reclining position and resting
– Double eyepatch
– No Myosis nor Mydriasis
– Cold pack first and then hot pack
– Sedation
– Hemostatic drug
– Operation —— high IOP
Lens Bruise
Change of lens transparence ——
Traumatic cataract
Treatment
Operation
Lens Bruise
Change of lens position
• Treatment
– Operation
Vitreous hemorrhage
Vitreous hemorrhage
• Treatment
– A little —— Self-absorption
– No absorption more than 3 months
—— Vitrectomy
– Retinal detachment —— Operation
Choroid Bruise
TreatmentTreatmentNo special treatmentNo special treatment
Retinal Commotion and Bruise
Ocular rupture• Clinical manifestation
– IOP
– Hyphema /vitreous hemorrhage
– Subconjunctival hemorrhage
or hematom
– Corneal deformation
– Limitation of eyeball movement
– VA —— no LP
• Treatment
– Exploration
– treatment
Ocular Penetration
Ocular Penetration
• Complications
– Traumatic iridocyclitis
– Intraocular foreign body
– Infectivity endophthalmitis
– Sympathetic ophthalmia
– Traumatic PVR
Ocular Penetration• Basic principle
– To Rehabilitate wound in time and recover ocular
integrity
– To prevent and treat infection and other
complications
• Operation : primary or secondary
• antibiotics : local / general
• Atropine
• Glucocorticoid / NSAID : local / general
Ocular Penetration
Foreign Body
Extraocular Foreign Body
Intraocular Foreign Body
Intraocular Foreign Body
• Treatment principle
– Diagnosis in time and operation at
the right moment in order to keep
and recover vision
Ocular Appendix Trauma
Eyelid Trauma
Orbital Trauma
Chemical Burn
Chemical BurnBase burn
– Tissue lysis , easy pervasion and
severe
– Blurred circumscription ,
progressive
– corneal epithelium exfoliation :
usual
– blood vessel invasion : obvious
– necrosis : pervasion to deep
– Intraocular damage : yes
Acid burn
– coagulation necrosis , reduce pervasion , not severe relatively
– Clear circumscription , no progressive
– corneal epithelium exfoliation :occasional
– blood vessel invasion : no obvious
– necrosis : limit to contact surface
– Intraocular damage : little
Chemical Burn
Chemical Burn• First aid : to rescue in time
– To disengage chemical contact immediately and rinse in locale as soon as possible : mass of water , long time
– Neutralization : acid —— 2 % Sodium bicarbonate, sulfadiazine base —— Vitamin C
• Infection prevention : antibiotic
• To promote healing : epidermal growth factor , Vitamin C
• prevention and cure symblepharon and other complication
– mydriasis : Atropine
– glucocorticoid
– Collagenase inhibitor
– Tear Substitute / contact lens
• Complication Treatment : Operation
THANK YOU!