UPDATE ON OCULAR TRAUMA

Posted by e-Medical PPT Thursday, February 23, 2012
Open Globe Injuries
Globe rupture: a F/T eye wall wound due to a BLUNT object(perforating injury)
Globe laceration: a F/T eye wall wound due to a SHARP object(penetrating eye injury)

Closed Globe Injuries
Ocular Surface Injuries
Traumatic S/Conj.Hrg
 360 deg +/- abn pupil ? open globe
 Rx: lubricating drops; stop aspirin if O.K.,NSAID’s
Conj. Laceration
 F/B trauma(poked in eye)
 ?scleral laceration(?PEI)
 <1cm- o/c AnB 5-7 days; must F/U in a few days
 >1cm-eye Sx referral re: PEI; suturing

Corneal Abrasion

Pain++,photophobia,redness,epiphora
 Fingernail,chemicals,FB’s(CL’s),trauma
Evaluation:
 Cobalt blue light-fluorescein staining
 Linear(esp.vertical)-FB!-Evert lid/s
Rx:
 Prompt referral-esp. if CL’s or organic material
 o/c AnB q.i.d. 3-5 days; MUST r/v next day & VA
 +/- cycloplegia( g.homatropine) q.i.d
 Analgesia prn
 Discard CL’s & CL’s case; No CL’s
 Do NOT need eyepad
 Warn- Recurrent Corneal Erosion Syndrome

Corneal Foreign Body
Grinding,drilling,welding,hammering(metal on metal),CL’s
Retained organic material,metallic FB,rust ring
Rx: Shallow FB
 S/L removal only if Amethocaine-soaked cotton bud unsuccessful
 o/c AnB +/- cycloplegia qid; analgesia prn
Prompt referral:
 >3 days epithelial defect
 Incomplete r/o FB; rust ring
 Deep FB ? PEI
Never provide anaesthetic drops(minims) to patients-delays corneal healing

Chemical Injuries
Ocular Emergency
 Alkalis- lime(CaO,plaster,concrete),oven & drain cleaners, ammonia
 Acids-toilet & pool cleaners, car battery fluid
Rx: Immediate copious irrigation-N/S or Hartmann’s solution 30’( or at least until ocular pH=7.5)
 N.B. White eye=poor prognosis(ischaemia)
 Corneal thinning+/- perforation=patch graft/PK
Poisons Information Centre: 131 126
Contact chemical’s manufacturer if ? Acid ?Alkali

Anterior Chamber Injuries
Traumatic mydriasis
Traumatic iritis:3-4 days post-trauma
Iris sphincter tear/iridodialysis
Hyphaema-A/C hrg+/- fluid level;’8-ball’;
  38% rebleed 3-5 days later
  Rx: Admit:kids,high IOP,rebleed,unreliable F/U,blood dyscrasias,severe
   Cycloplegia;top c/s;eye shield;bed rest(bathroom privileges)-45 deg.HoB;daily review;long-term F/U-WARN re:angle-recession glaucoma

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