OCULAR INJURIES BY DNYANESHWAR POTFODE

1. Ocular injuries
DNYANESHWAR POTFODE

3. • Now days increase the traffic and
industrialization, the incidence of
injuries is also increase.
• Eyes are also not exempt from these
injuries

4. Examination
• Patient review
– are there life threatening injuries which need to be treated
first?
brain injury
• Facial Exam
– lacerations/bruising, numbness, weakness
• Ocular exam
– VA, lids and lacrimal system, orbital rim/orbital bones,
ocular motility, globe, optic nerve

5. Examination
• Rule out life threatening injuries
• Rule out globe threatening injuries
• Examine both eyes
• Assess lid trauma - document +/- photos
• Plan for repair

6. Anterior Segment
Trauma

7. Assessment
• History
–Forces involved
–Blunt, FB?, Penetrating
–Chemical
• Acid?
• Alkali?
• Contact allergy?

9. Common Causes
• Abrasion
– Minor trauma - lash, finger
– Recurrent Epithelial Erosion Syndrome
– Plant
• Foreign body
– Grinding
• Penetrating Injury
– Hammering metal on metal
– Explosion
– Dirty / clean
• Blunt
– Fist
– Ball
– Bungy cord

10. Examination
• Visual Acuity
• Skin/lids
– Evidence of severity of injury
• Evert lids
– ? Subtarsal FB
– Look for fine scratches on upper cornea
• Conjunctiva
– Laceration
– Look carefully for scleral injury beneath
– Sub conj hemorrhage

12. Examination
• Cornea
– Fluorescein stain - abrasion/wound
– Leak
– Infiltrate
– FB
• Anterior chamber
– Cells
– Hyphaema
– Hypopyon

13. Examination
• Iris
– Transillumination defects
– Peaked pupil
– Dilated pupil
– Check for RAPD
• Lens
– Red reflex
– Stability
• IOP
– +/- angle

14. Iris trauma

15. RAPD

17. Corneal foreign body
• Grinding most common cause
• Usually do not need surgery
• Treatment
– Removal of foreign body with needle and/or burr
– Children may require GA

19. Corneal Abrasion
• Common
• Usually resolve quickly
• Very painful initially
• Treatment
– Exclude other injuries
– Chloramphenicol ointment
– Patch 24 hours
– +/- pain relief / sleeping tablets

20. Recurrent Epithelial Erosion
• History gives clue
• Often triggered by minor trauma
• Treatment
– Lubricants
– Bandage contact lens
– Epithelial debridement
– Tetracyclines
– Laser Phototherapeutic Keratectomy (PTK)
– Anterior Stromal Puncture

22. Hyphema
– Blunt injury
– Complications:
• Raised IOP
• Angle recession
• Corneal staining
• Rebleed
– Treatment
• Steroid
• Bed rest - debatable
• Frequent monitoring wrt IOP

25. Traumatic Uveitis
–Ranges from Mild to Severe
–Usually other injuries as well
–Treat as for normal uveitis but may not
require long taper

26. Flare

29. •Lids and orbits

30. Assessment
• History
– Detailed as possible
– Time and nature of injury
• Missile, blunt, ? FB remaining, chemical etc
– Past ocular history
• Previous VA and lid function
• remember trauma is a recurrent pathology
– Med Hx
• ?tetanus, ? Anticoagulation

31. Examination
• Rule out life threatening injuries
• Rule out globe threatening injuries
• Examine both eyes
• Assess lid trauma - document +/- photos
• Plan for repair

32. Examination - lids
• Tissue loss
• Layers of lid
• Lid Margin
• Canaliculi
• Prolapsed fat/septal involvement
• Levator function
• Lagophthalmos
• Canthal tendon/angle

33. Traumatic ptosis
• Trauma to levator aponeurosis and Mullers
muscle
• To repair need to identify levator aponeurosis
and reattach to tarsal plate
• GA (diffiult under LA)
• Beware involving septum
• Consider delayed repair (3/12)

35. Canalicular Lacerations
• Upper
– Controversial (loss may not affect pt)
– Either
• repair laceration and ignore canaliculus, or
• Stent canaliculus (Mini Monoka) and repair lac
• Lower
– Usually needs to be repaired
– Repair within 24-48 hours
– Stent
• bicanalicular or monocanalicular
• Leave in for 3-6 months
– 8.0 or 9.0 vicryl to canaliculus

38. Orbital Fractures
• classification
–Open or closed
–Internal (orbital skeleton)

40. Signs of orbital floor blow-out
fracture

41. •Examine and Diagnose ?

49. Thank you