Eye trauma
Abbas W abbas Ali M hroub
Objectives OTo know the common forms of eye
injury
OHow to take a hx, to do physical examination
OTo know the possible sites of injury and to take a general idea of each
one
Numbers O Ocular trauma is the cause of
blindness in about half a million people worldwide.
O50% of the total injuries occur in patients less than 25 yrs of age and
9-34% of them in pediatric group.
O-M>>F 4:1
Forms of injuryOForeign body injury
OBlunt trauma
OPenetrating trauma
OChemical trauma ( acidic or alkali )
Injury sites OAnterior segment (Conjunctiva,
Cornea, Iris, Lens)
OPosterior segment (Vitreous, Retina , Optic nerve)
OAdnexa (Eyelids, Lacrimal Structures )
OOrbital structures (Extraocular musclesbony walls )
Befor everything For all eye injuries:
O DO NOT touch, rub or apply pressure to the eye .
ODO NOT try to remove the object stuck in the eye.
O Do not apply ointment or medication to the eye .
OSee a doctor as soon as possible, preferably an ophthalmologist
determine the object
Symptomes and signs O The patient ’ s symptoms will relate
to the degree and type of trauma suffered.
OPain, lacrimation and blurring of vision, red eye are common features
of trauma
Omild symptoms obscure a foreign body injury
Examination O The examination will depend on the type of
injury. In all cases it is important that visual acuity is recorded in the injured and
uninjured eye for medico – legal reasons
OWithout a slit lampOWith a slit lamp
Orbital injuryOEmphysema
Opatch of paraesthesia
OLimitation of eye movements
O enophthalmos :the eye may become recessed into the orbit
Lid injury OHematoma (traumatic black eye)Olaceration
Lid laceration Tx OSuturing to retain lid contour
OIf one of the lacrimal canaliculi is damaged an attempt can be made to repair it, but if repair is unsuccessful,
usually the remaining tear duct is capable of draining all the tears.
OIf both canaliculi are involved, an attempt
at repair
Conjunctival injury OChemosis (edema of conjunctiva)OLacerationOSubconjunctival hemorrhage
Corneal injury OAbrasion
OForeign body
ORupture
Orecurrent corneal erosion.
Abrasion Most common eye injury
O loss of the epithelial layer OTypical causes: fingernails, mascara
brushes, debris, chemical injuries, extended use of contact lenses,
iatrogenicOThe instillation of fluorescein will
identify the extent of an abrasion
Corneal abrasion Tx OProphylactic antibiotic ointment, with
or without an eye pad .
ODilatation of the pupil with cyclopentolate 1% can help to
relieve the pain caused by spasm of the ciliary muscle
Foreign body
FB Tx Oremoved with a needle under topical
anesthesiaOSub tarsal objects can often be swept
away with a cotton - wool bud from the everted lid.
OThe patient is then treated as for an abrasion.
O-If Injury penetrated the globe, eye should be examined carefully with
dilation of pupil Oto see the lens and retina
Anterior chamber OHyphaema : accumulation of blood
in anterior chamberOcaused by rupture of the root of the
iris blood vessels, or iris dialysis (Torn away from its insertion to
ciliary body)COMPLICATIONS
Ore-bleeding (5-6 days after injury) ,Oincreased IOPO cornea staining with blood and
traumatic mydriasis
Tx -Children needs hospital admission for
few days-Adult treated at home -REST!!! -Steroids decrease risk of rebleeding ,
BB ,pupil dilation. ( No aspirin or NSAID)
-usually responds to medical treatment, but occasionally surgical
intervention is required
Rupture globe (Scleral rupture)
Ooccurs when the integrity of the outer membranes of the eye is disrupted by blunt or
penetrating trauma
Oophthalmologic emergency
Ooccur when a blunt object impacts the orbit, compressing the globe along the anterior-
posterior axis causing an elevation in intraocular pressure to a point that the sclera tears
26
Rupture globe (Scleral rupture)
It is critical to avoid putting pressure on a ruptured globe to prevent any potential extrusion of
intraocular contents and to avoid further damage
ODecrease in visual acuity, pain ,watering, redness.ODecrease in anterior chamber depth.ODecrease in IOPOIn penetrating injuries the shape of the pupil may be
distorted if the peripheral iris has plugged a penetrating corneal wound (uveal prolapse)
Treatment OPrehospital OA suspected or obvious ruptured
globe should be protected from any pressure or inadvertent contact with
a rigid shield during transport.OImpaled foreign bodies should be left
undisturbed.OEye patches are contraindicated
TreatmentOEROPlace Fox eye shield or other rigid
deviceOAdminister antiemetics (eg,
ondansetron) to prevent Valsalva maneuvers
OAdminister sedation and analgesics as needed
OAvoid any topical eye solutions (eg, fluorescein, tetracaine, cycloplegics) in cases of known globe perforation
or rupture
O Administer prophylactic antibioticsOEnsure the patient is kept nothing by
mouth (NPO)
Pupil OTraumatic miosis (due to iridocyclitis,
It occurs initially due to irritation of ciliary nerves
OTraumatic mydriasis (due to 3rd nerve palsy) + -blurring of vision
(loss of accommodation).
IrisOTraumatic iritis: inflammation of iris and
ciliary body after any type of trauma due to exposure of antigens .
OTraumatic sphincter tears defects in constrictor pupillae muscle at the pupillary border , V- shaped tears (avoid mydriatics)
OIridodialysis separation of the root of iris from its insertion on the ciliary body,
produce a D-shaped pupilOtraumatic aniridia
Ciliary body
OTraumatic spasm or paralysis of accommodation ... temporary myopia
OHypotony ; suppression of secretion of aqueous humour
OAngle recession glaucoma (2ry glaucoma) onset is often delayed
LensOSubluxation of the lens . It may occur due to partial
tear of zonules. The subluxated Lens is slightly displaced but still present in the pupillary area
O Odislocation >>fluttering of the iris diaphragm on
eye movement (iridiodonesis)
OTraumatic cataract after blunt or penetrating injury(Posterior sub-capsular), within hours and transient
OStar or stellate shape appears Vossius’ Ring
VitreousOHemorrhage If there is no red reflex
and no fundus details are visible, this suggests a vitreous hemorrhage
OFloaters OFloaters and spots typically appear
when tiny pieces of the vitrous break loose within the inner back portion of the eye.
OProlapse
Vitreous hemorrhageVitreous Hemorrhage Treatment:
Omay absorb over several weeks, or may require removal by vitrectomy
Optic nerve
OTraumatic optic neuropathy caused by avulsion of the blood vessels supplying the optic nerve.
O Although this is uncommon, it leads to a profound loss of vision and no treatment is available.
Ooptic nerve atrophy is often seen 3-6 weeks after the injury.
ChoroidO-Rupture: linear rupture, white lines, edges may be
covered with hemorrhage. (Asymptomatic or decrease in Visual Acuity)
O-Traumatic choroiditis
O-Effusion or hemorrhage may occur under theOretina (subretinal) or may even enter the vitreous
Oif retina is also torn .
O-Spontaneous choroidal detachment:O due to hypotony
Retina
OCommotio retinae damage to the outer retinal layers caused by shock waves that traverse the eye from the site of impact following blunt trauma
OUnder examination the ritina appears opaqe and white in colour most commonly seen in the posterior pole and may seen in the periphery but the blood vessles are normally seen
Ocharacterized by decreased vision in the injured eye a few hours after the injury
Symptoms 1 .spontaneous recovery in 3-4 weeks
2 .visual recovery is limited if associated with macular involvement
3 .degeneration, macular holes, choroidal rupture
Signs 1 .whitish-grayish opacification
2 .scattered retinal hemorrhages3 .cherry red fovea
RetinaCommotio retinae Treatment of
OIt usually spontaneously resolves, but requires careful observation
since retinal holes may develop in affected areas and may lead to subsequent retinal detachment.
46
ORetinal tears or retinal dialysis
ORetinal detachment
ORetinal hemorrhage
Retina
Treatment of Retinal dialysis: Osurgical intervention to repair
any detached retina
Retinal Hemorrhage
49
Penetrating TraumaClinical effects
1 .Mechanical:O wounds on cornea, conjunctiva and-sclera
O Uveal prolapseOtraumatic cataract
2 .Infection: severe in 24-48 hrs., fungal delayed
3 .Sympathetic ophthalmia: diffuse bilateral uveitis of both eyes after trauma to one eye,
may develop in days and up to several years… BlindnessSymptoms may develop from days to several years after a penetrating eye injury
Examination :Oeyes should be gently examined
OAvoid direct pressure on globe.
IOFB
OMetallic vs non metallicO Retained, iron - containing foreign bodies
may have an insidious and particularly devastating effect on the eye (siderosis oculi).Due to generation of free radicals
lead to Oa progressive, pigmentary degeneration of
the retina .OA discoloration of the iris (heterochromia) ,
Oa fixed mydriasis, O cataract can be a late clues to the diagnosis.
OFailure to detect and remove such a foreign body at the time of injury results in irreversible blindness
OCopper containing foreign bodies causes keyser feischer rings and endophthalmitis
53
Chemical injuryOAlkali more severe than acids because they
penetrate more.OThe conjunctiva may appear white and
ischemic. If such changes are extensive, involving the greater part of the limbal circumference, corneal healing will be grossly impaired because of damage to the epithelial stem cells of the cornea, which are located at the limbus
Chemical injury
OA prolonged epithelial defect may lead to a corneal ‘melt’ (keratolysis)
O There will be additional complications such as uveitis, secondary glaucoma and cataract.
Chemical injuryTreatment :
OThe most important part of the treatment is to irrigate the eye immediately with COPIOUS quantities of clean water at the time of the accident.
Oirrigate under the upper and lower lid to remove solid particles
Onature of the chemical can then be ascertained by history and measuring tear pH with litmus paper
OSteroids, pupil dilators.OVitamin C orally and topically to improve healing
and delay ulceration
Chemical injuryOAnticollagenases (e.g.: tetracycline) orally and topically to
reduce risk of corneal melting by inhibiting matrix metalloproteinases.
Olimbal stem cell transplantation
Oin case of extensive damage of limbus preventing re-epithelialization of cornea and as a result melting of it (keratolysis) with time. Cells are taken either from the normal, fellow eye or from a donor source
Ooverlay of amniotic membrane which protects and maintains the underlying tissue and promotes resurfacing.
This beautiful eye reflects the beauty of it’s creater
Thank you
Top Related