Caring for patients with eye injuries, neoplastic growth of the eye.
Lecturer: Lilya Ostrovska
Nature of Injury Blunt Lacerating Chemical
Blunt Trauma Mild – moderate
“bruise” ocular tissues Eye wall intact
Moderate – severe Rupture eye wall Very severe consequences
Lacerating Trauma “cut” eye wall Outcome depends on extent and location
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 muscles Bony walls
Disgusting Photographs Front to back…
Subconjunctival Hemorrhage
Corneal Foreign Body
Curling Iron Burn
Corneal Laceration
Iris Sphincter Rupture
Traumatic Cataract
Vitreous Hemorrhage
Retinal Hemorrhage
Optic Disc Hemorrhage
Orbital Wall Fracture
Common Minor Eye Injuries Corneal abrasion Corneal foreign body Chemical splash Traumatic iritis
Diagnosis History
Sharp vs blunt vs chemical injury
Exam CHECK VISION CHECK VISION CHECK VISION
Diagnosis cont. Exam – Pry lids apart!
Cornea clear? Pupil round? Pupil black? Blood clotted behind cornea?
Diagnosis cont. Exam
Red reflex? Eyes move symmetrically?
Fluorescein Test Topical “eye dye” COBALT light
Abrasion Treatment Erythromycin ointment +/- patch 1-2 day follow-up with eye doc
Corneal Foreign Body
Foreign Body Treatment Anesthetize eye Remove FB
Cotton swab (don’t worsen abrasion!) Kimura spatula +/- needle tip
E-mycin and +/- patch 1-2 day follow-up with eye doc
Chemical Treatment IRRIGATE Check pH Minor
E-mycin ointment 1 day follow-up eye doc
Major Same day eval by eye doc
Traumatic Iritis Moderate blunt injury Photophobia Lid bruising/edema Subconj heme or injection Pupil sluggish Eval by eye doc
Please Do Not Confuse Subconjunctival hemorrhage Hyphema
OCULAR ONCOLOGYOCULAR ONCOLOGY
OSSN Ocular surface squamous neoplasia Encompasses conjunctival/corneal intraepithelial neoplasia
(CIN)
Squamous conjunctival dysplasia Carcinoma in situ Invasive squamous cell carcinoma (SCC)
Squamous cell carcinoma
•Extensive
•Ill defined edges
•Vascularised
•Corneal involvement
Conjunctival melanoma Primary aquired conjunctival melanosis (PAM) Preexisting conjunctival naevus De novo
PAMBiopsy if:•Growth•Nodule formation•Vascularity
Primary acquired conjunctival melanosis
De novo conjunctival melanoma
Rx Conjunctival SCC / Melanoma
Excision / cryotherapy to cut conjunctival margin Topical Mitomycin C Episcleral plaque radiotherapy if recurrence
Congenital hypertrophy of the retinal pigment epithelium (CHRPE)
Choroidal neovascularisation: high myopia (Fuch’s spot)
Choroidal haemangioma
Melanocytic tumours of the posterior uvea
Naevus Melanoma
Drusen Fibrous metaplasia of RPE
Choroidal naevus
Uveal melanoma treatment Observation
Tumours < 2mm thick
• Symptoms• Thickness > 2mm• Orange pigment (lipofuscin)• Growth• Subretinal fluid• Peripapillary location
Uveal melanoma treatmentObservationTranspupillary laser thermotherapy (TTT)
Uveal melanoma treatment
ObservationTTTLocal resection
Anterior to equator
Base < 10mm
Uveal melanoma treatment Observation TTT Local resection Radioactive plaque therapy
Thickness < 8mmBase <15mm
Ruthenium 106
Iodine 125
Uveal melanoma treatment Observation TTT Local resection Radioactive plaque therapy Proton beam/helium ion irradiation Gamma knife therapy
Uveal melanoma treatment Observation TTT Local resection Radioactive plaque therapy Proton beam/helium ion irradiation Gamma knife therapy Enucleation
Base > 15mm
Metastatic tumoursBreast / lung carcinoma
AmelanoticMultifocalChoroidal
Treat only if sight affected
Amelanotic
Multifocal
Choroidal
Posterior to equator
THANKS FOR YOUR ATTENTION !