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Blunt trauma
Mild
moderate
Moderate
severe
eye wall
Outcome depends on extent and
location
Sources of Injury
Falls - 4%
Sharp objects - 18%
Location of Injury
Anterior
Segment
Posterior Segment
Adnexa
Orbital Structures
Anterior Segment
Conjunctiva
Cornea
Iris
Lens
Posterior Segment
Vitreous
Retina
Optic
nerve
Adnexa
Eyelids
Lacrimal
Structures
Orbital Structures
Extraocular
Bony
walls
muscles
Initial Examination
HISTORY
o mechanism of injury
abrasion, blunt force, penetrating object,
burns
o symptoms
o time of the injury
visual acuity prior to the injuryPrevious
injuries
Past ocular history
Past medical history
Initial Examination
PE:
Visual acuity
o Eye examination
o
Labs
and imaging
ER Management
Stabilize
patient
Obtain history
Address eye injury
Avoid unnecessary manipulation
Use medications with caution
Assessment
History
Detailed as possible
Time and nature of injury
Med Hx
?tetanus, ? Anticoagulation
Examination
Rule
Examination - lids
Tissue loss
Layers of lid
Lid Margin
Canaliculi
Image
CT
If
? FB
If unable to determine posterior aspect
of wound
If suspect orbital fracture/ other injuries
Repair
Timing
Patient factors
Gross swelling
Anaesthesia
GA / LA
wound
Remove FB
Minimal debridement
Careful handling of tissues
Careful alignment of anatomy
Close
in layers
Simple laceration
Deep lacerations
lid margin
Tarsal plate first
6.0 vicryl suture - can use as traction
3-4 sutures to plate
Spatulated needle is useful
Align
lashes - silk
Skin - nylon or gut or vicryl
Canalicular Lacerations
Upper
Lower
bicanalicular or monocanalicular
Leave in for 3-6 months
Complications
Lagophthalmos
Rare
Tearing
Infection
Hypertrophic scars
Traumatic ptosis
Myogenic or neurogenic
Orbital Fractures
Orbital #s
classification
Open or closed
Internal (orbital skeleton), rim, complex (internal +rim)
Type
Eyelids
Globe
Displacement, proptosis
Nerves - V1 & V2
Enophthalmos - if severe
Periocular ecchymosis Ophthalmoplegia and oedema
typically in up- and downgaze (double diplopia)
Infraorbital nerve
anaesthesia
Imaging
CT
MRI
Assessment
History
Forces involved
Blunt, FB?, Penetrating
Chemical
Acid?
Alkali?
Contact allergy?
Common Causes
Abrasion
Foreign body
Grinding
Penetrating Injury
Blunt
Fist
Ball
Bungy cord
Examination
Visual Acuity
Skin/lids
Evert lids
Conjunctiva
Laceration
Look carefully for scleral injury beneath
Sub conj hemorrhage
Examination
Cornea
Anterior chamber
Cells
Hyphaema
Hypopyon
Examination.
Iris
Lens
Transillumination defects
Peaked pupil
Dilated pupil
Check for RAPD
Red reflex
Stability
IOP
+/- angle
RAPD
RAPD
Relative
afferent
pupillary defect
Corneal Abrasion
Common
Usually
resolve quickly
Very painful initially
Treatment
Exclude other injuries
Chloramphenicol ointment
Patch 24 hours
+/- pain relief / sleeping tablets
w+XDwvc
Hyphaema
Blunt injury
Complications:
Raised IOP
Angle recession
Corneal staining
Rebleed
Treatment
Steroid
Bed rest - debatable
Frequent monitoring wrt IOP
Traumatic Uveitis
Ranges
Iris Dialysis
Cataract
Hyphe
ma
Subconjunctiv
al
Hemorrhage
Iridodialys
Thermal Burn
Chemical trauma
Alkali
Alkali
Acids
Acids
Patients
Treatments
Early
Standard Treatments
Antibiotics
Cycloplegic agents such as atropine
or cyclopentolate can help with comfort
Artificial tears- and other lubricating eye
drops
Steroid drops- In the first week
following injury, topical steroids can help
calm inflammation and prevent further
corneal breakdown.[14]