Professional Documents
Culture Documents
Trauma
• “the most under recognized major health
OCULAR TRAUMA problem today”
• “study of injury” could significantly “reduce
mobility and realize savings in both financial
mobility and realize savings in both financial
and human terms”
John D. Conklin Jr. MD
Associate Professor
Comprehensive Ophthalmology
University of Kentucky
OCULAR TRAUMA Epidemiology of US Eye Injuries
• permanent impairment to the visual system is • 2.4 million cases annually
rated nearly equal to impairment of the • about 1 million suffer permanent visual
“whole man” impairment and > 75% monocular blindness
• ie
ie. total loss of vision in one eye equals 25%
total loss of vision in one eye equals 25% • majority <30 years of age
j i 30 f
impairment of visual system and 24% impairment
of whole man • > 3yoa, most common cause of enucleation
Epidemiology of US Eye Injuries Economics of Ocular Trauma
• #1 cause of monocular blindness • NSC suggests job‐related incidents cost $300
• #2 cause of visual impairment million annually
• #1 cause of eye‐related admissions • 1985 6 mo. urban hospital study estimates $5
million in annual direct/indirect costs
million in annual direct/indirect costs
• <3¢ of every dollar is spent on eye injury
research despite the CDC’s affirmation that
such research “will more than pay for itself by
reducing economic burden of injury and
disability.”
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Reduction of Incidence of Ocular
Trauma
• PBA study: 90% of eye injuries are
preventable
• Eye Injury Registry of Alabama
• data collection focusing on
data collection focusing on
• incidence ● prevalence
• demographics ● causative factors
Selected Data
• Prevention via Education 1988-2007
• eg. cooperative effort between US/Canadian eye MDs N=16,364
significantly decreased hockey‐related eye trauma
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Birmingham Eye Trauma Terminology Birmingham Eye Trauma Terminology
System (BETTS) System (BETTS)
• comprehensive standardized system of eye Endorsed by the: Mandated by:
trauma terms to provide simple unambiguous • American Academy of • Graefe’s Archives
Ophthalmology • Klinische Monatsblätter
and consistent classification • International Society of • Ophthalmology
• see handout
see handout Ocular Trauma
Ocular Trauma
• Retina Society
• United States Eye Injury
Registry
• Vitreous Society
• World Eye Injury Registry
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Ocular Trauma Categories Chemical Burns
• chemical burn • vision‐threatening injury requiring acute
• blunt/lacerating injury intervention
• intraocular foreign body • types
• conjunctival/corneal foreign body • alkalai (eg. cleaning agents, fertilizer, pesticides)
lk l i ( l i t f tili ti id )
• acid (eg. car battery fluid)
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Chemical Burns
• management:
• topical anesthetic
• direct copious irrigation for 15 – 20 minutes
• inspect for foreign bodies and removal
inspect for foreign bodies and removal
• check pH via litmus paper
• evaluate visual acuity
• Penlight w/cobalt blue filter to look for swelling,
opacities and defects
• if defect, patch with topical antibiotic/cycloplegic
Chemical Burns
• REFER stat if:
• burn
• reduced vision
• severe chemosis
severe chemosis
• cloudy cornea
Blunt/Lacerating Injury
• etiology: sports, fights and MVAs
• mechanism: contusion may tear tissues or
rupture globe
• sequelae:
l
• globe rupture/penetration
• hyphema
• lid lacerations
• orbital tissue contusion and bony fractures
• coincidental facial/intracranial injuries
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Blunt/Lacerating Injury Blunt/Lacerating Injury
• history is key! • exam
• nature of object • topical anesthetic with lids open for vision (but do
• site of impact not pry open)
• severity of blow
severity of blow • lid laceration/proptosis
lid laceration/proptosis
• age of injury • check EOMs and MB
• reduced vision or field of vision, diplopia and/or • inspect for small laceration/holes in lids
pain? • absent red reflex?
Blunt/Lacerating Injury
• look for:
• severe chemosis/subconjunctival hemorrhage
• correctopia
• corneo/scleral laceration
corneo/scleral laceration
• globe deformation
• hyphema
CAUTION: if suspect open globe, DO NOT
forcibly open/retract lids!!
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Management of Uncomplicated Lid
Lacerations
• antiseptic cleaning
• close with 6‐0 Vicryl or Silk
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TO REFER OR NOT TO REFER?
REFER if:
• abnormal vision • corneo/scleral laceration
• severe pain • deformed globe
• correctopia • hyphema
• complex lid laceration
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IOFBs IOFBs
• sequelae: if delayed intervention, • REFER: immediately if history of high speed
• cataract missile (even if no physical signs)
• glaucoma
• retinal trauma/hemorrhage
retinal trauma/hemorrhage
• chronic metallic toxicity
• loss of vision
• prognosis: potentially good if early treatment
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Subconjunctival/Corneal
Foreign Bodies
• exam:
• check vision
• inspect corneal/conjunctival surfaces with light
and magnification
and magnification
• perform upper lid eversion and check inferior
cul‐de‐sac
• apply fluorescein for defeccts
Subconjunctival/Corneal Subconjunctival/Corneal
Foreign Bodies Foreign Bodies
• etiology: airborne debris • treatment
• history: • conjunctival/corneal foreign body – remove via
• “blew into eye” cotton swab/bent tip needle using slit lamp
• foreign body sensation acutely or starts slowly
f i b d i l l l • if defects, patch with topical antibiotic ointment
if defects patch with topical antibiotic ointment
and cycloplegic
• photophobia/tearing
• eye MD in 24 hours
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Subconjunctival/Corneal
Foreign Bodies
REFER:
• if unable to remove foreign body, apply eye
shield
• if large corneal abrasion or foreign body
if l l b i f i b d
sensation without foreign body identification
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Hyphema Hyphema
• mechanism: concussive force shears iris root • management:
blood vessels resulting in blood in anterior • eye shield and immediate referral to eye MD
chamber • treatment by eye MD:
• complications: • shield at all times
shield at all times
• reduced physical activity
• harbinger of more serious globe injury
• rest with head of bed at 30°
• re‐bleed in 30% cases leading to potentially
• topical cycloplegic/steroid
blinding glaucoma
• daily eye exam for initial 5d
• if necessary, hospitalization
Prevention of Eye Injuries
• education (esp. monocular patients!)
• occupation/activity specific safeguards
• protective eye guards (ANSI approved) for:
• carpentry/metal work
t / t l k
• sports
• contact (hockey, football, basketball)
• projectile missiles (baseball, lacrosse, racquet sports)
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Prevention of Eye Injuries
• wear goggles/plastic spectacles if using:
• jumper cables/car batteries
• chemical sprays/cleaning fluid
• darts, pellet/BB guns, fishing hooks, fireworks,
bow/arrows, lawn mowers, weedeaters, and
champagne corks
• wear 100% UV blocking sunglasses if exposed to
sunlight/snowfields
• NEVER stare into sun, eclipse, tanning or arc‐
welding lamps
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Case Presentation I
A 4 year old girl presents after falling while
running with a pair of scissors. Her parents
are concerned because she complains of
tearing and foreign body sensation in her left
tearing and foreign body sensation in her left
eye. There were no witnesses to the incident.
How do you proceed?
Case Presentation II
A 34 year old woman presents with complaints
of pain in each eye with complete loss of
vision OD and following pictures. She denies
antecedent trauma illness or surgery What
antecedent trauma, illness or surgery. What
do you do next?
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References
• The Physician’s Guide to Eye Care
Trobe, Jonathan D. 1993 AAO
• Paton and Goldberg’s Management of Ocular
Injuries Second Edition Deutsch TA and
Injuries, Second Edition. Deutsch, TA and
Feller, DB. 1985
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