Ocular Injuries 09

8/8/2019 Ocular Injuries 09

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OCULAR INJURIESOCULAR INJURIES


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OCULAR INJURIESOCULAR INJURIES

Mechanical (dullMechanical (dullcontusions andcontusions andwounds)wounds)ChemicalChemicalThermalThermal

ElectricalElectricalRadiationalRadiational

Perforating injuriesPerforating injuries

Superficial injuriesSuperficial injuriesextraocular foreign

bodiesCorneal abrasion


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Contusional injuriesContusional injuries

The orbit.The orbit. There may occur fracturesThere may occur fracturesof the orbital walls. Commonestof the orbital walls. Commonestbeing the blowbeing the blow- -out fracture of theout fracture of theorbital floor. Orbital haemorrhageorbital floor. Orbital haemorrhagemay produce sudden proptosis,may produce sudden proptosis,sometimes may be enophthalmos.sometimes may be enophthalmos.

Orbital emphyseme may occurOrbital emphyseme may occurfollowing ethmoidal sinus rupturefollowing ethmoidal sinus rupture


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The lidsThe lidsSubconjunctivalSubconjunctivalhaemorrhage,haemorrhage,laceration andlaceration andavulsion of the lidsavulsion of the lidsTraumatic ptosisTraumatic ptosis

may follow damagemay follow damageto the levatorto the levatormuscle.muscle.


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Contusional injuriesContusional injuriesLacrimal apparatusLacrimal apparatus-- laceration oflaceration oflacrimal passageslacrimal passages

especially theespecially thecanaliculi.canaliculi.ConjunctivaConjunctiva - -subconjunctivalsubconjunctival

haemorrhage,haemorrhage,chemosis and tearschemosis and tearsof conjunctivaof conjunctivaCornealCorneal abrasionabrasion


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Contusional injuriesContusional injuriesScleral Scleral tears (globe tears (globe rupture)rupture)

Anterior chamber Anterior chamber

changes: hyphaema,changes: hyphaema,collapse of the collapse of the anterior chamber anterior chamber Iris, Pupil and CiliaryIris, Pupil and Ciliary

body:body: traumatic traumatic miosis, traumatic miosis, traumatic mydriasis, ruptures of mydriasis, ruptures of the pupillary margin,the pupillary margin,iridodialysisiridodialysis


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L ensL ens lesionslesions --concussion cataract,concussion cataract,subluxation of the subluxation of the lens, dislocation of lens, dislocation of the lensthe lensVitreous bodyVitreous body haemophthalmoshaemophthalmos


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Contusional injuriesContusional injuriesChoroidal Choroidal and and retinal retinal choroidal and retinal choroidal and retinal haemorrhages,haemorrhages,

ruptures of the ruptures of the choroid, commotiochoroid, commotioretinae, retinal retinae, retinal detachment.detachment.Optic nerve Optic nerve injuriesinjuriesTraumatic Traumatic glaucoma glaucoma or traumatic or traumatic hypotonyhypotony


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Perforating injuriesPerforating injuriesDiagnosis.Diagnosis.R eliable signsR eliable signs

ofperforative injuries:ofperforative injuries:1 . Visible wound 1 . Visible wound 2. Prolapse of inner 2. Prolapse of inner structuresstructures3. Hole in the iris3. Hole in the iris

4. Intraocular foreign 4. Intraocular foreign body (proved by X body (proved by X- -rayrayexamination)examination)


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Perforating injuriesPerforating injuriesImmediate management of globalImmediate management of global

perforation:perforation:1 . Antibiotics (systemically)1 . Antibiotics (systemically)2. Tetanus antitoxin should be 2. Tetanus antitoxin should be administered administered 3. Antibacterial drops3. Antibacterial drops4. Binocular bandage 4. Binocular bandage


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intraocular foreign bodies (IOFB).intraocular foreign bodies (IOFB).DiagnosisDiagnosis ::hystoryhystory, , ocular examination ocular examination, , X X--

ray examination ray examination, , radiographic localization radiographic localization by Kombergby Komberg- -Baltin Baltin Bone Bone--free X free X--rays are used to determine the rays are used to determine the

position of non position of non- -metal (glass, wood) foreign metal (glass, wood) foreign bodies. Ultrasonography and CTbodies. Ultrasonography and CT- -scan scan localization is useful in diagnosis of IOFBlocalization is useful in diagnosis of IOFB


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Perforating injuriesPerforating injuriesTreatment:Treatment: IO FB should always be IO FB should always be

removed.removed.The way of IO FB removing depends on itsThe way of IO FB removing depends on its

localization. There are three main ways:localization. There are three main ways:1 ) anterior (when IO FB is situated in the 1 ) anterior (when IO FB is situated in the

anterior segment),anterior segment),

2) direct (when IO FB is located by the site 2) direct (when IO FB is located by the site of injury),of injury),

3) transscleral (the commonest way).3) transscleral (the commonest way).


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Perforating injuriesPerforating injuriesComplicationsComplications

traumatic cataract,traumatic cataract,

introduction of introduction of infection,(infection,(post post--traumatic iridocyclitis,traumatic iridocyclitis,

purulent uveitis,purulent uveitis,endophthalmitisendophthalmitispanophthalmitispanophthalmitis


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ComplicationsComplicationsreaction of fo reign reaction of fo reign bodies (bodies (Side rosisSide rosis,,ChalcosisChalcosis))sympathetic sympathetic ophthalmitisophthalmitis


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EndophthalmitisEndophthalmitisSymptoms:Symptoms: ocula r pain,ocula r pain,

redness, lac rimat ion ,red ness, lac rimat ion ,ma rked l oss o f v ision , l id ma rke d l oss o f v ision , l id o e dema, ma rke d o e dema, ma rke d c ircum ciliary in je ction ,circum ciliary in je ction ,corn e al o e dem a , exu dat e s corn e al o e dem a , exu dat e s in pup illary ar e a , pup il in pup illary ar e a , pup il sho ws y e llo w ref lex due sho ws y e llo w ref lex due to pu rule nt exu dation in to pu rule nt exu dation in v itro us .v itro us .


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EndophthalmitisEndophthalmitis

T rea t men t:T rea t men t: in clude broa d spe ct rum in clude broa d spe ct rum an tibioticsan tibiotics -- t op ica lly ( in form of t op ica lly ( in form of

sub conjun ctiva l, re t robu lbar an d sub conjun ctiva l, re t robu lbar an d in t ra vit reous inje ctions, drops) an d in t ra vit reous inje ctions, drops) an d sys t em ica lly; my dr ia tics, cor ticos t ero ids.sys t em ica lly; my dr ia tics, cor ticos t ero ids.

Enuclea tion may be performe d in case th e Enuclea tion may be performe d in case th e pa tien t does no t respon d t o th e urgen t pa tien t does no t respon d t o th e urgen t in t ens ive th erapy in cluding vit re ct omy.in t ens ive th erapy in cluding vit re ct omy.


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PanophthalmitisPanophthalmitis

S y mp to m s S y mp to m s : s e ve re ocular : s e ve re ocular pain and he adach e,pain and he adach e,co mp le t e loss o f vision ,co mp le t e loss o f vision ,pro fus e w at e ring, pu rule nt pro fus e w at e ring, pu rule nt dischar ge; m ark e d re dn e ss dischar ge; m ark e d re dn e ss and exophthal m os .and exophthal m os .

Associat e d constit utional Associat e d constit utional sy m pto m s ar e m alais e and sy m pto m s ar e m alais e and fe ve r.fe ve r.


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PanophthalmitisPanophthalmitisS y m pto m s S y m pto m s : O e dem a and : O e dem a and hyp e ra em ia o f th e lids ,hyp e ra em ia o f th e lids ,exophthal m os , ocular exophthal m os , ocular m oveme nts ar e lim it e d m oveme nts ar e lim it e d

and pain full, chem osis o f and pain full, chem osis o f th e con ju nctiva , m ixe d th e con ju nctiva , m ixe d in je ction , corn e a is clo udy in je ction , corn e a is clo udy and o e dem ato us , ant e rior and o e dem ato us , ant e rior

cha mbe r is full o f p us .cha mbe r is full o f p us .V ision is co m ple t e ly lost V ision is co m ple t e ly lost and p e rce ption o f light is and p e rce ption o f light is abs e nt . G lo be p e rf oration abs e nt . G lo be p e rf oration m ay occur at limbu s .m ay occur at limbu s .


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Sympathetic ophthalmitisSympathetic ophthalmitisIt may develop about 4It may develop about 4- -12 weeks after12 weeks after

either an injury or rarely intraoculareither an injury or rarely intraocularsurgery on the eye. It is thought tosurgery on the eye. It is thought to

be that injury to one eye results inbe that injury to one eye results inprogramming of the body to produceprogramming of the body to produceocular disease autoimmune in natureocular disease autoimmune in natureand predominantly a Tand predominantly a T- -cellcell

lymphocyte reaction in the injuriedlymphocyte reaction in the injuriedand the sympathizing other eye.and the sympathizing other eye.SignsSigns is typical for iridocyclitis oris typical for iridocyclitis or

neuroretinitisneuroretinitis


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Sympathetic ophthalmitisSympathetic ophthalmitis

TreatmentTreatmentSteroid therapySteroid therapy - - systemic,systemic,periorbital injections, frequentperiorbital injections, frequentinstillation of topical drugsinstillation of topical drugs2. Midriatics (topically)2. Midriatics (topically)

3. Antibiotics3. Antibiotics4. In severe cases4. In severe cases - -immunosuppressive therapyimmunosuppressive therapy


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Chemical injuriesChemical injuries

Grading of chemical burns.Grading of chemical burns.I. H yp eraemia of t he c o njunc t iva and er os i o n s I. H yp eraemia of t he c o njunc t iva and er os i o n s

and o edema of and o edema of c o rneal e p i t helium c o rneal e p i t helium II. I s chemia of t he c o njunc t iva (i t bec o me s II. I s chemia of t he c o njunc t iva (i t bec o me s

gre y i s h, chem ot ic). Area s of cl ou ding ma y gre y i s h, chem ot ic). Area s of cl ou ding ma y a pp ear in c o rnea (a s t he re su l t of in f il t ra t i o n).a pp ear in c o rnea (a s t he re su l t of in f il t ra t i o n).

Ma y be l oss of c o rneal s en s ivi ty in t hi s st age.Ma y be l oss of c o rneal s en s ivi ty in t hi s st age.III. T ot al c o rneal e p i t helial l oss, st r o mal cl ou dingIII. T ot al c o rneal e p i t helial l oss, st r o mal cl ou dingIV.Dee p c o nju nc t ival necr os i s and c o rneal IV.Dee p c o nju nc t ival necr os i s and c o rneal

necr os i s . C o rnea i s china in c o l ou r necr os i s . C o rnea i s china in c o l ou r


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Chemical injuriesChemical injuries

Immediate treatment:Immediate treatment: t horoug h wash wit h t he t horoug h wash wit h t he availa ble cle an wa te r. The g re a te r t he t ime availa ble cle an wa te r. The g re a te r t he t ime betwee n in ju ry and de cont amina tu ion, t he betwee n in ju ry and de cont amina tu ion, t he worse t he p rognos is. Me chanical re moval worse t he p rognos is. Me chanical re moval of contominan t f rom t he con ju nc t ival sac and of contominan t f rom t he con ju nc t ival sac and corne al su rf ac e. Ant ibac te rial drops and corne al su rf ac e. Ant ibac te rial drops and oint me nt. I n ca se of bu rns of IIoint me nt. I n ca se of bu rns of II --IV grad esIV grad estet an us an t itox in shou ld be admini ste re d.tet an us an t itox in shou ld be admini ste re d.Treatment:Treatment: I rriga t ion of fu racillini so lut ion or I rriga t ion of fu racillini so lut ion or

normal saline 0,9%: an t ibac te rial drops and normal saline 0,9%: an t ibac te rial drops and oint me nt; mydria t ics ( in form of drops);oint me nt; mydria t ics ( in form of drops);anal get ics fo r pain ; an t ihist amin e drugs; vit amin anal get ics fo r pain ; an t ihist amin e drugs; vit amin C C


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Radiation burnsRadiation burns

In f rared b u rn s In f rared b u rn s (( lid oede ma and eryt he ma lid oede ma and eryt he ma,,catara ct catara ct,, ret ina l oede ma, vitreo us and ret ina l ret ina l oede ma, vitreo us and ret ina l hae morr hage hae morr hage ))Ion izing rad iat ion Ion izing rad iat ion ((conj u n ct iva l hyperae mia,conj u n ct iva l hyperae mia,cir cumc ornea l inje ct ion, rad iat ion kerat it is cir cumc ornea l inje ct ion, rad iat ion kerat it is ,,catara ct catara ct,, intraret ina l hae morr hage s ,intraret ina l hae morr hage s ,pap illoede ma and centra l ret ina l ve in pap illoede ma and centra l ret ina l ve in t hrombo sis )t hrombo sis )

Ultra violet rad iat ion Ultra violet rad iat ion (P hoto(P hoto--opt ha lmia opt ha lmia s ympto ms :s ympto ms : severe burning pain, photophobia,severe burning pain, photophobia,lacrimation, blepharospasm, swelling of palpebrallacrimation, blepharospasm, swelling of palpebralconjunctiva, conjunctival hyperaemia.)conjunctiva, conjunctival hyperaemia.)


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PhotoPhoto- -opthalmiaopthalmia

TreatmentTreatmentA nalget ics (top ical and oral) A nalget ics (top ical and oral)A nt ibiot ic drops and oit me nt A nt ibiot ic drops and oit me nt Cold compressesCold compresses

P rophylaxisP rophylaxis -- u lt raviolet bu rns ma y be ult raviolet bu rns ma y be

pre ve nte d by use of o rdinar y crown glasspre ve nte d by use of o rdinar y crown glassor regu lar glass le nses, as t hey abso rb t he or regu lar glass le nses, as t hey abso rb t he ra ys.ra ys.

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Ocular Injuries 09