PENETRATING TRAUMA

DR RAHEELA NAZ
PGR EYE UNIT 2
LAY OUT
• BETTS CLASSIFICATION
• MODES OF INJURY
• EFFECTS OF PENETRATING INJURY
• FIRST AID
• EVALUATION
• CLINICAL FEATURES
• MANAGEMENT
BETTS CLASSIFICATION
MODES OF INJURY
• Trauma by sharp and pointed
instruments----needles, knives,
pens, glass pieces, arrows etc

• Trauma by FBs travelling at very

high speed----bullet injuries, iron
FBs
EFFECTS OF PENETRATING INJURY
• Mechanical effects of the trauma
• Introduction of the infection
• Post-traumatic iridocyclitis
• Sympathetic ophthalmitis

RISK FACTORS :
• delay in primary repair
• ruptured lens capsule
• dirty wound
FIRST AID

• Wound toilet
• Cleaning and dressing of the wound
• Application of shield in case of rupture globe
• Systemic antibiotics and analgesics
• Tetanus immunization
EVALUATION
• Complete history
• Systemic examination
• Visual acuity
• Ocular examination using slit lamp and ophthalmoscope
• Investigations :
X-rays(AP and lateral)
USG
CT scan
MRI
STRUCTURE CLINICAL FEATURES MANAGEMENT
CORNEA KEY SIGNS :  Small shelving---
• Peaked pupil spontaneous/bandage contact
• Shallow AC lens
 Medium-sized---suture
 With iris involvement—iris
abscission
 With lens damage--

SCLERA Anterior lacerations(associated with Better prognosis

iridociliary prolapse, vitreous Laceration repair with uveal tissue
incarceration) repositioning and vitreous cut flush

Posterior lacerations(associated with Primary repair of the sclera

retinal damage)