Ocular trauma

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 Ocular Injuries and it is nature.
The eyeball is well protected from direct trauma by the
projecting margins of the bony orbit and by the eyelids. The
blinking reflex and the protective action of the eye lashes
often prevent the entrance of F.B. which might cause damage
to the cornea.
Injuries to the eyeball and its adnexae will be discussed under
the following headings:
1.Chemical injuries.
2.Thermal injuries.
3.Mechanical injuries: this can be discussed under the
following subheadings:
l Non-perforating injuries (contusions by blunt instruments).
l Perforating injuries without retained F.B.
l Perforating injuries with retained F.B.
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Epidemiology of Ocular Trauma
Ocular trauma is an important, preventable
public health problem worldwide.
As many as half a million people in the
world are blind as a result of ocular injuries.
Such injuries also are common causes of
monocular blindness; one third to 40% of
monocular blindness may be related to
ocular trauma.

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EPIDEMIOLOGIC FEATURES
IN OCULAR TRAUMA

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Birmingham eye trauma
terminology (BETT).

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 History.
It is important to obtain a detailed history of an ocular injury. Such
information may be obtained from a variety of sources, including the
patient, first responders, or others involved or associated with the
accident. Information should include the
4 w's (where, when, who, and what), that is, the site of accident,
the time and date, the individuals involved, and a detailed description
of the circumstances.
If chemical exposure was involved, available material safety data
sheet (MSDS) information should be sought. Critical data includes
Type of chemical—alkali, acid, solvent,Volume of spillage,The pH of
the material,The concentration of the material,The solubility of the
material,The contact time.
Emergency medical care by the first responders.Product
manufacturer.Availability of chemical data. Regional poison control
center.Internet.The detail and accuracy of the history obtained at the
time of, or subsequent to, admission.
The thoroughness of the admission examination.
The correlation of critical results with medication and/or other
treatment,provided to the patient.

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 Examination.
Visual acuity (each eye separately)—with best correction or pinhole
done prior to further examination or treatment except for chemical
injury where the procedures are reversed.

Inspection of the ocular structure—if laceration of globe suspected no

pressure should be exerted on the globe.

Position of the eyes and eye movements (six cardinal positions).

Examination of the pupils for size and reaction to light.

Gross visual fields—by confrontation.

Ophthalmoscopy.

Intraocular pressure (IOP), if acute glaucoma is suspected.

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Location of Injury
Anterior Segment ,Posterior Segment,Adnexa and Orbital
Structures

Anterior segment. Adnexal

Conjunctiva
Cornea Eyelids
Iris Lacrimal Structures
Lens
Posterior segment.
Extraocular,orbital
Vitreous Extraocular muscles
Retina Bony walls
Optic nerve

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Raccoon(black) Eye

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Subconjunctival Hemorrhage

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Corneal Foreign Body

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Corneal Abrasion

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Curling Iron Burn

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Hyphema

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Traumatic Cataract

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Vitreous Hemorrhage

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Retinal Hemorrhage

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Optic Disc Hemorrhage

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 Common Minor Eye Injuries
History.
l Sharp vs blunt vs chemical Use Fluorescein Test.
injury
Examination. Use fluorecine dye strips.
--Visual acuity…if possible… After installing topical anesthetic
Separate lids apart! drops(tetracaine),with the use of
l Cornea clear? cobalt blue light of the slit lamp…
l Pupil round? so you define the extent and
l Pupil black? depth of any scratch ,abrasion or
l Blood clotted behind cornea? ulcer in the cornea.
In the anterior
chamber(hyphema)
l Red reflex?
l Eyes move symmetrically?

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Corneal Abrasion
Antibiotic drops
and ointment…
Erythromycin
ointment
Pad and
bandage.
1-2 day follow-
up…complete
epithelial
healing

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Corneal Foreign Body
Anesthetize eye
Remove FB
l Cotton swab (don’t worsen
abrasion!)
l Kimura spatula
l +/- needle tip
Erythromycin eye ointment and
+/- patch
1-2 day follow-up…complete
healing…

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Chemical Treatment
first aid Traumatic Iritis

IRRIGATE with copious Moderate blunt injury

clean water Photophobia
Check pH… Lid bruising/edema
Minor Subconjunctival
l Erythromycin ointment hemorrhage or injection
l 1 day follow-up eye doc
Pupil sluggish
Major Evaluation by eye doctor.
l Same day evaluation by eye
doctor.

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 Thermal injuries
l flame,
l contact with hot ashes or hot fluids.

Thermal burns usually affect the lid, and rarely involve the eyes unless
the heat is intense and prolonged.
Clinical picture
Burns of the conjunctiva: evident as hyperemia with violent
chemosis or as grayish-white coagulated plaques.

Burns of the cornea: superficial burns form a grayish or yellowish

clouding of the corneal epithelium, epithelial erosion .
Deeper burns produce grey or whitish areas, penetrating deeply into
the corneal stroma, which develop into an ulcer which may lead to
perforation

Treatment
Avoidance of sepsis (antibiotic).
The preservation of a seen eye with normally functioning eyelids.

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 summary

Blunt ocular trauma can be

anywhere .
Mild – moderate "bruise” ocular tissues…Eye wall intact
Moderate – severe, Rupture eye wall, Very severe consequences

1-injuries of the lids

l Ecchymosis (black eye).
l Surgical emphysema.
l Bruising and laceration of the lid.
2-conjunctiva
l subconjunctival hemorrhage.
l Chemosis
l Bruising and laceration.
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Adnexal injury, lid laceration

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3-cornea
Epithelial abrasion.
Corneal laceration
Contusion oedema of the stroma.
Blood staining of the cornea.
(hyphaema)
4-Sclera
Rupture of the globe.
5-Anterior Chamber
hyphaema.(blood in the anterior chamber).
Post-concussional glaucoma(due to hyphaema,
inflammation,angle resession).

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6-Iris & ciliary body 10-Vitreous.
Vitreous hemorrhage.
Iridodialysis.(disinsertion of the iris)
Clouds of fine pigmentary
Traumatic miosis. opacities.
Traumatic mydriasis. 11-Optic N.
Cyclodialysis.(ciliary body disinsertion) O.N laceration.
7-Choroid Hemorrhage in the O.N sheath.
Rupture of the choroids. 12-Orbit and extra-ocular m.
Choroidal hemorrhage. # of the orbital rim.
8-Retina Retrobulbar hemorrhage.
Traumatic Ptosis.
commotio retinae.(retinal edema)
Traumatic paralytic squint.
Macular degeneration.(hemorrhage)
Macular hole.
Retinal tear and detachment.
Retinal dialysis.
9-Lens
Cataract.
Subluxation and dislocation.

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Fractured orbital wall.

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 Perforating injuries
sharp objects with high impact energy or flying pieces of metal or
glass & may remain in the eye as an intra-ocular Foreign
Bodies(IOFB) or Lacerating Trauma "cut” eye wall,
Outcome depends on extent and location

History of war injury(explosives),hammer and chisel worker…

Clinical feature .
1.IOP greatly diminished.
2.If the cornea is perforated, the AC disappears or become very
shallow.
3.The prolapsed of the intra-ocular contents, iris prolapsed …
4.Alteration in the pupil shape, size or laceration.
Treatment.
Install antibiotic eye drops , cover the eye gently without pressure
and refer to eye specialist.

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 Primary prevention
The primary prevention of work-related disorders depends on the
reduction or elimination of exposure to factors causally associated
with those disorders in individuals susceptible to such stressors.
In the past, emphasis has been placed on risk factors that are
physical in nature, such as lighting, terminal design, and posture.
However, other factors such as workers' job satisfaction and relations
with supervisors have been specifically noted to have a relatively
strong relationship to visual and other apparently ergonomic
complaints.
Primary prevention of work-related complaints may depend on
reducing exposure to physical, personal, and psychosocial stress.

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Secondary prevention. Tertiary prevention
efforts are aimed at in the work setting involves
reducing disability and prevention of recurrences in a
hastening recovery once a patient. Initially the job tasks
and person-job fit should be
health concern has evaluated.
become apparent. This is Next, job or task modification or
a more targeted approach, workstation changes may be
in that it has become necessary. Repetitions,
apparent which workers abnormal postures (especially
will develop complaints, the type of corrective lenses in
illnesses, or injuries. presbyopes), and other
Secondary prevention ergonomic problems should be
involves working in addressed.
partnership with the
worker.

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