3. Introduction
It is said that “ Eyes are window to the soul
and to the outer world.”
Ocular trauma is a major cause of
preventable monocular blindness and visual
impairment in the world, especially in the
developing countries
Ocular trauma and resultant loss of vision
leads to psychological, economical and
professional crippling of the patient.
4. Epidemiology
Bimodal age distribution: children and young
adults;>70 yrs of age
M/F: 3-5x
Lifetime prevalence 20%: 3x recurrence risk
workplace, sports, falls(elderly)
PUBLIC HEALTH ISSUE
5. TheWHO Programme for the Prevention of
Blindness, suggests that annually
55 million eye injuries restricting activities more
than one day
750,000 cases will require hospitalization
200,000 open-globe injuries
approximately 1.6 million blind from injuries
2.3 million people with bilateral low vision
19 million with unilateral blindness or low vision.
6. Classification of Ocular Trauma
The Birmingham EyeTraumaTerminology
System (BETTS) devised a classification for
ocular trauma which is accepted worldwide.
It is unambiguous, consistent and simple.
10. Open Globe Injury
Classification
Type
1. Rupture
2. Penetrating
3. Intraocular
4. Perforating
5. Mixed
Grade- visual acuity
1. ≥20/40
2. 20/50 to 20/100
3. 19/100 to 5/200
4. 4/200 to light perception
5. No light perception
Pupil
Positive-RAPD+ in
affected eye
Negative-No RAPD in
affected eye
Zone
I. I- Isolated to cornea
(Including the
corneoscleral limbus
II. II- Corneoscleral limbus
to a point 5mm posterior
into the sclera
III. III- Posterior to anterior
5mm of sclera
11. Closed Globe Injury
Classification
Type
1. Contusion
2. Lamellar laceration
3. Superficial foreign body
4. Mixed
Grade- visual acuity
6. ≥20/40
7. 20/50 to 20/100
8. 19/100 to 5/200
9. 4/200 to light perception
10. No light perception
Pupil
Positive-RAPD+ in
affected eye
Negative-No RAPD in
affected eye
Zone
I. External (limited to
bulbar cj, sclera, cornea)
II. Ant seg (structures
internal to cornea
including PC, pars
plicata)
III. Post seg- all structures
post to PC)
12. Calculating the OTS : variables and raw
points
Variable Raw points
InitialVision
NLP 60
LP/HM 70
1/200- 19/200 80
20/200-20/50 90
≥20/40 100
Rupture -23
Endophthalmitis -17
Perforating Injury -14
Retinal Detachment -11
Afferent pupillary defect -10
Ref : Kuhn F, Maisiak R, Mann L et al.The ocular trauma score Ophtalmol Clin N
Am 2002 : 15: 163-165
13. OTS: Categorization and potential
visual acuity outcomes
Sum of
raw
points
OTS No PL PL/HM 1/200-
19/200
20/200-
20/50
≥20/40
0-44 1 74% 15% 7% 3% 1%
45-65 2 27% 26% 18% 15% 15%
66-80 3 2% 11% 15% 31% 41%
81-91 4 1% 2% 3% 22% 73%
92-100 5 0% 1% 1% 5% 94%
Ref : Kuhn F, Maisiak R, Mann L et al.The ocular trauma score Ophtalmol Clin N
Am 2002 : 15: 163-165
15. Evaluation of case of trauma
Proper history
Systemic examination
Visual acuity testing
Thorough Ophthalmic examination using slit
lamp and ophthalmoscope, when feasible
In case of chemical injuries, take quick history
and give immediate eyewash and treatment.
Defer any evaluation till then.
16. History
Sudden/ gradual changes in vision since the trauma
occurred
Pain, diplopia and photophobia
Date and time of incident.
Mechanism of injury
Accidental, intentional or self inflicted
Where it occurred- home, workplace
Use of glasses or protective eyewear
Mechanical trauma with a foreign object
Size and shape
Distance from which it came
Exact location of impact
17. Cases of foreign bodies
Composition of FB, contamination
Origin and exact mechanism of impact
Single/multiple
Injuries from animals
Type of animal and nature of injury
Try to locate the animal to test for transmissible
diseases
Chemical Injuries
Nature of chemical
Check pH if sample available
18. Past ocular history
Pre-existing ocular diseases
Previous ocular surgeries
Visual acuity prior to incidence
Intraocular or periocular appliances
IOL
Scleral buckle
Glaucoma drainage implant
Tetanus immunization
Any treatment taken for the injury in detail
19. Systemic Examination
General Condition of patient
Associated head injury, fractures
Any systemic conditions that may need urgent
intervention
20. Location of Injury
Anterior segment
Posterior segment
Adnexa
Orbital structures
21. Ophthalmic Examination
Record visual acuity on Snellen’s chart
Test each eye individually
Vn with spects
If not available,Vn with pinhole
Near vision
In case of no PL, check with brightest light available (e. g. IDO)
Keep a record
Colour vision
Ophthalmoscopic examination- direct and indirect
Slit lamp examination
Photography
Proper documentation and medico-legal case
registration
22. Visual field by confrontation test
IOP recording
Deferred until nature of injury is established- open
globe/closed
Can be done by Schiotz, Applanation or hand
held devices
23. Head Posture
Facial Symmetry
Eye alignment
Orbital Fractures- crepitus, infraorbital hypesthesia,
restricted EOM
Extra-ocular movements- cranial nerve involvement,
entrapment of muscle
Eyebrows, eyelids and eyelashes-
Abrasions, CLWs, marginal and canthal tears including
canalicular tears- probing
Ecchymosis, edema
Ptosis, FB, enophthalmos/exophthalmos
29. Routine haematological investigations
Radiological Imaging-
Plain Radiography- if CT and MRI not available
X-ray orbit AP and Lateral view, PNS
Orbital fractures
IOFB and intraorbital FB
30. Computed Tomography
Indicated if bone involvement is suspected
Plain/contrast
Axial sections- Globe, MR and LR, medial and lat
walls of orbit
Coronal Sections- SR and IR, roof and floor of orbit
Indications
Open globe injuries-
Post seg visualization
Suspected Intraocular and intraorbital FB and
haemorrhage
Orbital fractures
31. Magnetic Resonance Imaging
Indications- soft tissue lesions
To visualise periocular soft tissues
Suspected vascular lesios, intracranial pathology,
optic nerve lesions
Non magnetic intraocular or intraorbital FB
Contraindicated in metallic FB, pacemakers and
implants
32. Ultrasonography
Best resolution of post seg (0.1 to 0.01mm)
Extreme caution in c/o open globe injuries-
preferably avoided
Indications
Vitreous haemorrhage, PVD
Retinal tears and detachment
Choroidal rupture, suprachoroidal Haemorrhage
Scleral rupture
To visualize Lacrimal gland, EOM, soft tissues, FB
34. First- Aid
Thorough eyewash- FB , chemical injuries
Cleaning and dressing of the wounds
Do Not give pressure on the eyeball in cases
of globe rupture
Apply a shield in case of open globe injuries
Tetanus immunisation
Systemic Analgesics and antibiotics
36. Black Eye
Blunt truma to eye
Massive lid edema,
ecchymosis
marked chemosis
Fundus- may show Berlin’s
edema
USG B scan
X-ray orbit AP lat view
M/t-
analgesics-anti-
inflammatory,
localAntibiotic e/d
Close follow up
37. Lid Injuries
Commonly associated with
polytrauma
Consider patients systemic status
before deciding further
management
Examination
Examine thoroughly the lids, globe,
adnexal tissue, orbit and face
Extent of wound- involvement of
orbital septum, muscle, lid margin,
canaliculus, medial and lateral canthal
injuries
See for tissue loss
Rule out orbital fractures
Look for any foreign bodies in wound
Handle gently
38. Principles ofWound Repair
Re-establish the integrity of basic lid parts- ant.
Lamella, post lamella, levator, canaliculi and canthal
tendons
Identify landmarks and reattach them- wound angles,
apex of skin flaps, brow hairline
Do not incorporate orbital septum in the repair
Can be usually done under LA
Sutures-
6-0 polyprolene, nylon , silk
Can use 6-0 polyglycolic acid in young pts
Skin sutures removed after 5-7 days
Major lid reconstructive procedures to be done after
3-6 months
39. Non- marginal Lid Lacerations
Subcutaneous closure
Use 6- 0/5-0 Polyglactic acid (vicryl) suture
For suturing of deeper tissue and to anchor it to the
periosteum
Not necessary to suture the orbital septum
Tissue loss- consider skin grafts/ flaps
40. Marginal Eyelid Lacerations
Clean, anaesthetize and inspect the
wound
Freshen edges, separate ant and
post lamella by blunt dissection
Tarsus approximated by 5-0Vicryl
suture
Pass the needle through partial
thickness 2mm from lacerated
edge and exit at mid depth
Minimum 2-3 sutures passed and
left untied
Pass 5-0 silk suture at level of
meibomian glands vertical
mattress fashion
Tie both the sutures now
Skin closure with 7-0 Nylon or vicryl
and incorporate silk suture ends in
it keeping the knot away from
cornea
41. Canalicular Lacerations-
Lacerations near medial canthus- do probing and
check if any part is exposed
Management-
Monocanalicular stent- for external 2/3rds of one
canaliculus
Donut stent-silicone bicanalicular stent wih a
pigtail probe
Crawford stent
42. Post-operative Care
Keep wound clean and dry
Ice packs to reduce edema
Pressure patching- upto 1
week- avoid in children, open
globe injury repair, one eyed
pts
Antibiotic eye ointment,TDS
for 1 week and systemic
antibiotics
Skin sutures removed on
days 5-7
Margin sutures left for 2
weeks, stents for 3-6 months
Complications
Scarring
Cicatricial
entropion/ectropion
Watering
Exposure keratopathy
Traumatic ptosis
43.
44. Traumatic Sub-Conjunctival
Haemorrhage
Traumatic
Rule out causes of
Spontaneous SCH-
Valsalva maneuvers- coughing,
sneezing, vomiting, wt lifting
Acute bact/viral conjunctivitis
Systemic HTN , anticoagulants
M/t- rule out any other ocular
injuries
Wait and watch
Lubricating and antibiotic
eyedrops
Oral vitaminC
45. Corneal Abrasion
MC form of ocular trauma
Causes- f/b, rubbing,
fingernail injury, thrown
object, chemical exposure
Presentation- intense pain,
redness, photophobia, DOV
Clinical Features-
Lid edema
CC+ CCC+
Cr epi defect
Fluorescien staining
Associated keratitis in contact
lens users/tree branch injury
See for sub-tarsal FB in linear
abrasions
46. Treatment-
Debride any loose epithelium with a wet cotton
swab/ sharp blade
Removal of any FB in fornices and over cornea
Broad spectrum antibiotics, tear substitutes,
cycloplegics
Patching of eye- controversial
Avoid in cases of vegetative trauma, associated
keratitis
Re-examine patient after 24 hours
47. Corneal Foreign Body
MC seen in workplaces-
grinding, drilling, hammering,
welding, also while driving
Proper history
Record visual acuity
Ocular Examination-
Rule out IOFB and deeper
injury
FB in fornices
Extent of FB in cornea
Seidel’s test
Iritis,AC cells, flare
Cataractous changes in lens
Dilated fundus for IOFB
48. Treatment
• Superficial- remove with cotton
swab
• Deep- 26 no needle
• Metallic FB- remove the rust ring
•Approach the cornea tangentially
•Antibiotic ointment, cycloplegic if
required, patch the eye for 6 hours
•Follow up after 24 hours
•Use of dark goggle
•Very deep FB- ideal to remove
under microscope as suture may be
needed if perforation occurs
•Inform patient abt developmet of
corneal opacity
•Use of protective eyewear
49. Traumatic Mydriasis
Frequent complication of
ocular trauma
Cause-
injury to iris sphincter and
dilator muscles, iris nerves
and ciliary body
Leads to dilatation of pupil
and paralysis of
accomodation
Clinical Features
Dull aching pain
watering, photophobia,
blurred vision
ocular fatigue
Treatment
Pilocarpine e/d
Tinted contact lenses
Surgical repair
50. Hyphema
Blood accumulation in AC
2/3rd cases in closed globe
injuries and 1/3rd in open
globe injuries
Clinical Features
Symptoms- pain, photophobia,
reducedV/A
RBCs and proteinaceous
material in AC
Whole AC may be filled with
clot
Corneal blood staining
IOP- variable
High chances of rebleeding
after 3-5 days
51. Management
USG B scan- to rule out post
seg involvement
Topical Prednisolone acetate
1 % e/d- frequency depends
on extent of hyphema
Cycloplegics
Anti glaucoma medications-
topical and systemic
Wear eye shield
Propped up position and bed
rest
Warning signs of rebleeding
explained to pt
Daily follow up
52. Surgical Intervention
AC wash with/ without trabeculectomy
Small gauge bimanual vitrectomy
Avoid forceful and vigorous manipulation
Indications
Corneal blood staining
Total hyphema with IOP> 50mm Hg > 5days
Unresolved after 9 days of t/t
53. Complications
Corneal blood staining
Peripheral anterior synechiae
Ischemic optic neuropathy
Optic atrophy, Decreased vision and visual field
defects
Amblyopia in children d/t corneal blood staining
54. TRAUMATIC CATARACT
Seen in contusive eye trauma
immediately or after years
Reported in 11 % eyes with closed
globe injuries
Mechanism- coup and contrecoup
Cinical Features
Associated with injuries to other
structures
Phacodonesis
Capsular tears
Vitreous prolapse
Most commonly ant and post
subcapsular cataracts- rosette shaped
Predisposition to progress to mature
cataracts
55. Management
USG B scan- to rule out retinal detachment,tear, IOFB
In early stages, refraction
For advanced cataracts, phacoemulsification and IOL
implantation
Use of capsular hooks and CTR in c/o capsular
instability
Pars plana vitrectomy and lensectomy
Preferable to do Posterior capsulotomy and ant
vitrectomy in children to avoid PCO
Early surgery will prevent amblyopia in children
56. Traumatic Luxation of Lens
Lens drawn away from
the site of zonular
rupture
AC- asymmetric
Lens may dislocate in
AC, posterorly or
extruded
Symptoms- diminution
of vision, monocular
diplopia,
Management
Spectacles/contact lenses
Miotics
Mild- Capsular hooks/CTR
with phacoemulsification
and PCIOL
Severe- ICCE with ACIOL
Severe with vitreous
prolapse- PPV +
lensectomy
Lens in AC- anti-
inflammatory, anti-
glaucoma, DO NOT
DILATE- lens extraction
with ACIOL or SFIOL
Lens in vitreous cavity-
PPV with
phacofragmentation
57.
58. Commotio Retinae
MC retinal manifestation of
contusive injury
Mechanism- damage to
photoreceptor outer segment
and RPE- coup and countercoup
injury
Clinical Presentation
Confluent geographic areas of
retinal whitening
In mid-perphery
Involving macula- Berlin’s edema
A/w acute vision loss if macula
involved
Management
Rule out associated injuries
Wait and watch
59. Traumatic Vitreous Haemorrhage
Clinical Features
sudden, punctate or web like
floaters
Decreased visual acuity
Seeing red
Diagnosis
Ophthalmoscopic examination
USG B scan-
Mild to moderateVH-mobile
opacities
MarkedVH- dense echoes
Positional shifting of
Haemorrhage differentiates from
RD
Management
Closed globe injury withVH, no
RD/break-
bed rest, head elevation
Re-examination within 2 weeks
for resolution/RD
Non-resolvingVH- Persisting
for 2-3 months-Vitrectomy
Associated with RD- early
vitrectony
Complications
Secondary open angle
glaucoma
Hemosiderosis
PVR,Tractional RD
Synchysis scintillans
60.
61. Choroidal rupture
Traumatic break in RPE, Bruch’s
membrane, and underlying choroid
Classically crescent shaped with
tapered ends concentric to Optic
nerve
Direct/indirect – may involve macula
Immediate -loss of vision-
involvement of macula or serous
detachment, retinal edema,
haemorrhage
Late- ERM, CNVM, serous RD
Management
Regular fundus examination 6 monthly-
to detect CNVM
For CNVM- observation,
photocoagulation, photodynamic
therapy, anti-VEGF agents
62. Suprachoroidal Haemorrhage
Haemorrhgic choroidal detachment a/w accumulation of
blood in potential space between choroid and sclera
Rupture of long/short post ciliary arteries r ciliary body
vessels
a/w penetrating ocular injuries
Presentation-
Shallow/flatAC, with/without expulsion of intraocular contents
Pain, raised IOP
Fundus- dark, dome shped elevation of retina, choroid- loss of red
reflex, apex towards post pole
USG- non- mobile, flat/dome shaped echo dense opacities in
suprachoroidal space
Management
A/w closed globe injury- observe
Drainage, if indicated- on day 7-14
A/ w open globe- early surgical intervention
63. Traumatic Retinal Detachment
Various predisposing conditions which have a
common final outcome i. e. retinal detachment
are
Retinal Dialysis
Giant RetinalTears
Horseshoe tears
Necrotic Retinal Breaks
Vitreous base avulsion
Traumatic posterior vitreous detachment
Pars plana tears
64. Retinal Dialysis
Disinsertion of the retina
from non-pigmented pars
plana epithelium at the ora
serrata
Retina remains attached to
vitreous base
MC location
Inferotemporal quadrant
and in traumatic cases-
superonasal
May remain undiagnosed
for long periods d/t
minimal symptoms
65. Giant Retinal Tears
Extends from min 90
degrees/ 3 clock hours
Typically located in
inferotemporal and
superonasal quadrants
a/w posterior vitreous
detachment
66. Horseshoe Tears
Areas of strong
vitreoretinal adhesion
cause retinal break
during
traumatic/spontaneous
PVD
They take shape of a
horseshoe
Globe deformations and
torsion leading to PVD
and fluid collects
subsequently in the
subretinal space
67. Necrotic Retinal Breaks
Seen posterior to ora serrata
Direct contusive damage, retinal vascular
damage and retinal capillary necrosis leads to
weakened retina and irregularly shaped
retinal breaks
Detachment tends to form within 24 hours
68. Vitreous Base Avulsion
Occurs commonly after blunt trauma
Associated with pars plana tears, retinal
dialysis, retinal tears
Bucket handle appearance- stripe of
translucent vitreous over the retina
May be asymptomatic, but should search for
associated conditions
69. Treatment
Wait and watch
Prophylactic laser retinopexy/ trans-scleral
cryopexy- peripheral retinal breaks
Aim of surgery- close all retinal breaks and
relieve vitreoretinal traction
Surgical techniques- pneumatic retinopexy,
scleral buckling and/or PPV
Giant retinal tears- PFC stabilization,
lensectomy, , silicon oil tamponade
RD with pars plana tears/ retinal dialysis- scleral
buckling with trans-scleral cryotherapy or PPV,
air-fluid exchange, internal drainage of SRF and
endolaser photocoagulation
70. Traumatic Optic Neuropathy
Intracanalicular part is
most vulnerable
Mechanism of damage to
optic nerve
Direct deformation of skull
and optic canal
Shearing of ON
microvasculature
Tearing of nerve axons
Contusion against optic canal
Presentation
Profound visual loss, loss of
centralVA
Visual field defects
RAPD
Colour vision defects
Management
CT gold standard
Observation
High dose corticosteroids -IV
methylprednisolone 30
mg/kg f/b 15 mg/kg 6 hourly
Optic canal decompression
71. Orbital Trauma
Orbital injury can be contusive/ penetrating
Evaluation-
Periorbital oedema, lacerations, FB
Ptosis- edema, haemorrhage, neurogenic
Crepitus/bony discontinuity- orbital fractures
Enophthalmos-large orbital #
Exophthalmos- edema, haemorrhage, bony
fragments, air
EOM- muscle entrapment, IR mostly involved
Check Sensations- infraorbital nerve distribution
Nasal passages- epistaxis, CSF rhinorrhea
72.
73. Blowout Fractures
Expansion of orbital volume due to fracture of the thin
orbital walls into adjacent paranasal sinuses
‘Hydraulic theory’ and ‘buckling theory’
Axial and Coronal CT scan
Management
Systemic oral antibiotics, nasal decongestants, ice packs
Surgery indicated-
Entrapment of IR or perimuscular tissue with diplopia
Significant enophthalmos upto 7-10 days
High risk injuries for enophthalmos
Large floor/medial wall #
Combined medial wall and floor #
74. Surgery-
MedialWall-Floor / transcaruncular incision
Orbital floor
approached through transconjunctival/ sunciliary
incision
Entrapped tissues are released
Orbital implant- nylon sheets, polyethylene, teflon,
bone
75. Open Globe Injuries
Globe rupture- full thickness eyewall injury
caused by blunt trauma
Laceration- full thickness eyewall wound
caused by sharp object
Corneal laceration
Corneoscleral laceration
Scleral laceration
76. Ophthalmic Examination
360 degreee sub-conjunctival haemorrhage
‘Jelly Roll’ chemosis
Relative asymmetry in AC depth-
shallow in injuries ant to ciliary body
deep – post seg involvement
Transillumination defects in iris- path of projectile
injuries
Violation of ant capsule, focal cataract
Seidel test
Rule outVH, IOFB, RD by dilated examination
77. Management
Avoid manipulation of eye, put a protective
shield over the injured eye
Timing of the surgery depends upon systemic
condition of the patient
Repair can be performed under Peribulbar
anaesthesia in adults and under GA in
children
Start systemic antibiotics- IV
aminoglycosides and 3rd generation
cephalosporins
78. Surgery
Examination of eye under microscope and
devise a surgical strategy
Goals
Close the globe with minimal manipulation
Reposit/ excise exposed intraocular contents
Explore the globe for unrecognized injuries
Decrease the risk of endophthalmitis and
maximize chances of functional recovery by
restoring ocular integrity
79. Corneal Lacerations
Small, self-sealing clean
corneal lacerations without iris
incarceration- cyanoacrylate
glue application
Large lacerations
Limbal paracentesis site
created
Injection of viscoelastic
substance in AC
Iris repositioned, if necrotic
abscission required
Thorough wash with BSS
Sutures taken with 10-0
nylon, start with central
suture
Wound divided in two halves
at the pass of each suture
75% and 90% depth of suture
pass optimal for healing
Depth equal on either side,
adequate tension
Longer passes- less
astigmatism
Adequate sutures in
periphery, less near visual axis
Sutures rotated and buried
once the wound is stabilized
Subconj inj antibiotic and
steroid is given, eye patched
and shield placed
80. Corneoscleral Laceration
Larger wound with higher incidence of uveal
prolapse or incarceration
Primarily stabilize the limbus by a 9-0 nylon
suture
Repair in anterior to posterior direction
81. Scleral Laceration
Identify the posterior extent of the laceration
Dissect overlying conjunctiva andTenon’s
capsule
Sutures taken with 8-0 or 9-0 nylon
Initially place one or two central sutures for
easier repositioning of uveal tissue
Suture pass should be atleast 50% depth, full
thickness passes avoided
Interrupted sutures preferred, ends are cut and
rotated if possible
82. Rectus muscle laceration- muscle is secured with
double armed 6-0 vicryl, disinserted from globe,
and resutured after wound closure to its original
attachment
Posterior scleral lacerations
360 degree conjuctival peritomy
Isolate all recti on muscle hhoks and secure with loop
of 2-0 braided polyester suture
Suturing performed, most post part may be leftto heal
by secondary intention
Tissue loss- scleral or corneal patch graft
Conjunctiva closed with 6-0 vicryl
84. Ruptured Globe Repair
Exploratory surgery
360 degree conjunctival peritomy
Bipolar cautery for haemostasis
Wound closure performed as described
earlier
85. Post-operative Management
Thourough clinical examination
Topical antibiotics, steroids, cycloplegics, tear substitutes
IOP lowering agents in case it is elevated
Eye shielded, avoid strenuous activities
Continue systemic antibiotics, shift to oral
Use of soft bandaged contact lenses
VR consultation in cases of
IOFB
Endophthalmitis
RD,VH
Posterior scleral rupture/ laceration
Choroidal detachment, dislocated lens
Frequent follow-ups
Suture removal after 4-6 weeks
86. Complications and Outcomes
Poor prognostic signs-
Initial visual acuity at presentation
Length and width of laceration
Lacerations of recti
Involvement of lens
VH, RD
Endophthalmitis, sympathetic ophthalmia
Irregular astigmatism- Rigid gas permeable
contact lenses can be used
87. Intraocular Foreign Bodies
Penetrating ocular trauma with IOFB is a
challenging situation for an ophthalmologist
Diagnosis requires thorough history,
examination and proper imaging
88. Ophthalmic examination
Subconj haemorrhage, iris transillumination defects
Hyphema, focal lens opacity
Corneal/scleral laceration
Violation of ant or post lens capsule
VH, intra/ sub-retinal haemorrhage
Relative hypotony
Visible FB
Gonioscopy- FB in angle
Mainstay in imaging- USG and CT, preferably
helical CT with 1mm cuts
89. Management
Anterior chamber FB
Entry wound in cornea is
closed as described earlier
Limbal paracentesis/ clear
corneal incision made
away from the wound
FB directly visualised, use
of surgical gonioscopy lens
(Koeppe’s lens)
Grasped with forceps and
removed, may need
bimanual manipulation
Metallic FB – use of
intraocular magnet
90. Intralenticular FB-
can be managed by lens extraction by phacomulsification
and forceps extracion of FB
Posterior segment FB
Immediate removal is advocated
Stabilization of the wound
Pars plana lens extraction
Stabilization and repair of retina
Forceps/ magnetic removal of FB
Scleral buckling, intravitreal
injections
92. Sympathetic Ophthalmia
Bilateral granulomatous uveitis
MC following open globe injury (incidence 0.2 to
0.5%), may also occur after intraocular surgery
Pathophysiology-
Traumatic injury- uveal antigens are exposed-
autoimmune response
Exciting/injured eye and sympathizing/ normal eye
both become inflamed
A/w HLA-A 11 is shown
Onset- 2 weeks to 6 months after injury, mostly within
3 months
93.
94. Clinical Features
Mild pain, photophobia, DOV
Mutton fat keratic precipitates
Granulomatous panuveitis with prominent vitritis
Choroidal lesions- multifocal, placoid, cream colored-
Dalen Fuch’s nodules
Optic nerve hyperemia, swelling
FA- multiple hyperfluorescent sites leak in late phase
Management
Prevention- enucleation of severely injured eye
T/t-
High dose steroids with tapering
Cyclosporine, azathioprine, chlorambucil, methotrexate
97. Chemical Injuries
True ocular emergencies, every second
counts
Immediate irrigation is vital
Check pH in cul de sac if possible.
Type of chemical
Alkali- most severe damage- rapid penetration-
saponification of cell membranes, denaturation of
collagen
Acids- less damage- hydrogen ion precipitates
proteins and prevents penetration
104. Electrical Injuries
Point of entry and exit
Clinical Features-
Lid burns- entry wound
Corneal interstitial opacities
Iritis, miosis, spasm of accomodation
Electric cataract
Retinal edema, papilloedema, RD , chorioretinitis
Optic neuritis
105. Radiational Injuries
Ionizing radiations- X rays, beta rays
Loss of lashes, entropion, ectropion
Conj scarring
Cataract
UV radiations
Damage to corneal epithelium
Cataract formation
Visible radiation
Thermal injuries
Sun gazing l/t damage to macula
Infrared radiation- Glassblower’s cataract
Welding arc injuries
106. Prevention
Patient education
Use of protective eyewear at workplaces and
in sports activities
Use of helmet while riding two wheelers
Parent education to avoid eye injuries with
household items in children
Safety norms should be introduced in
workplaces regarding protection of eyes
107. Take Home Message…
Immediate treatment is directed at preventing
further injury or vision loss
Never think of the eye in isolation, always compare
both eyes
Always record visual acuity as it has important
medicolegal implications
A visual acuity of 6/6 does not necessarily exclude a
serious eye injury
Beware of the unilateral red eye as it is rarely ‘just’
conjunctivitis
Documentation
Use of protective eyewear
108. References
Indian J Ophthalmol. 2013 Oct; 61(10):
539–540 PMCID: PMC3853447 Ocular trauma,
an evolving sub specialty Sundaram
Natarajan
Ngrel AD, Thylefors B. The global impact
of eye injuries [J] Ophthalmic Epidemiol.
1998;5:143–69. PubMed
Ocular trauma by James T. Banta
Clinical Diagnosis and management of
ocular trauma by Garg, Moreno, Shukla et
al