8.ocular trauma
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TRAUMA1. Eyelid
2. Orbital blow-out fractures• Floor• Medial wall
• Blunt• Laceration
3. Ocular blunt and penetrating trauma• Anterior segment• Posterior segment
5. Intraocular foreign bodies
6. Chemical injuries
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Basal skull fracture - bilateral ring haematomas (‘panda eyes’)
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Repairing Lid lacerationCarefully align to prevent notching
Close tarsal plate with fine absorbable suture
Place additional marginalsilk sutures
Close skin with multiple interrupted 6-0 black silk sutures
Align with 6-0 black silk suture
Lid margin should be apposed precisely
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Canalicular laceration
• Repair within 24 hours• Chronic treating (epiphora) if not recognized
Or properly repaired
• Locate and approximate ends of laceration• Bridge defect with silicone tubing• Leave in situ for about 3 months
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The orbital rim protects the eye from injury by large objects
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• Periocular ecchymosis and oedema• Infraorbital nerve anaesthesia
• Ophthalmoplegia - typically in up- and down- gaze (double diplopia)
• Enophthalmos - if severe
Signs of orbital floor blow-out fracture
Hyposthesia: infraorbital nerve injury
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Investigations of orbital floor blow-out fracture
• Right blow-out fracture with ‘tear-drop’ sign
Coronal CT scanX-ray
1. Caldwell’s ( anterior posterior) view
2. Waters view – floor #
3. Lateral view
4. Submental vertex view zygomatic #
MRI: limited value
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Surgical treatment of blow-out fracture
Surgical repair in 2 weeks • Coronal CT scan following repair of right blow-out fracture with synthetic material Defect repaired with synthetic material
Autogenus: bone cartilage or facia
a b
c d
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Medial wall blow-out fracture
Signs
• Release of entrapped tissue• Repair of bony defect
Periorbital subcutaneous emphysema Ophthalmoplegia - adduction and abduction if medial rectus muscle is entrapped
Treatment
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Protective eyewears
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Def: Hemorrhage in space b/n the conj. And sclera
Causes: Blunt trauma Rubbing the eye
Strenuous activity
Rx. Resolves in 5 – 10 days
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Blunt ocular trauma
Equatorial expansion 128% increment
AP shortening 40%
Coup injury Counter coup
Small object
Force transmission
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Anterior segment ocular blunt trauma
Sphincter tear
Cataract Angle recession
Hyphaema
Lens subluxation
Iridodialysis Vossius ring
Rupture of globe
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Macular hole Optic neuropathyRetial tears
Posterior segment complications of blunt trauma
Choroidal rupture Commotio retinae Vitreous hemmorhage
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Hyphema
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Penetrating Trauma
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Penetrating trauma
Flat anterior chamber
Vitreous haemorrhage
Damage to lens and iris
EndophthalmitisTractional retinal detachment
Uveal prolapse
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Lacerations
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Traumatic Endophthalmitis
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Intraocular foreign bodies
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Intraocular foreign bodies
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Intraocular foreign bodies
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Detection and localization of IOFB
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Immediate IOFB Removal Depends on the site
Management of IOFB
Tetanus prophylaxis
IV antibiotics
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Retained IOFB
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Chemical burn
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Alkaline burn
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Acid burn
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Grading of severity of chemical injuries
• Clear cornea
Grade I (excellent prognosis)
• Limbal ischaemia - nil
• Cornea hazy but visible iris details
Grade II (good prognosis)
• Limbal ischaemia < 1/3
• No iris details
Grade III (guarded prognosis)
• Limbal ischaemia - 1/3 to 1/2
• Opaque cornea
Grade IV (very poor prognosis)
• Limbal ischaemia > 1/2
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Treatment of Chemical Injuries
1. Copious irrigation ( 15-30 min ) - to restore normal pH
2. Topical steroids ( first 7-10 days ) - to reduce inflammation
3. Topical and systemic ascorbic acid - to enhance collagen production
4. Topical cycloplegic - to reduce pain
5. Topical and systemic tetracycline - to inhibit collagenase and neutrophil activity
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Ultraviolet light burns
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Solar eclipse burn
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Management of Ocular trauma at GOPD
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Management of Ocular trauma at GOPD
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THANK YOU!
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