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Eye trauma: Penetrating and
blunt
Eye trauma: Penetrating and
bluntAdapted from source
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Anatomy
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Blunt eye injuries
contusions
subconjunctival haemorrhages
corneal foreign bodies &
abrasions
hyphaema
burns
blow-out fractures
retrobulbar haemorrhages
other
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Sport classification and risk
Collisionfootball, rugby, hockey
Contactwrestling
Non-contacttrack, tennis, rowing, swimming, x-country running
Otherbowls, golf, archery, field events
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Risk cont
Low risk
= no use of ball, bat, puck, stick, racquet AND nobody contact
track, field, swimming, gymnastics, cycling High risk
baseball, raquet sports, golf, water polo, fencing
Very high riskboxing, wrestling, contact martial arts
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The big five for red eye:
1. subconjunctival haemorrhage2. corneal foreign bodies
3. corneal abrasions
4. hyphaema
5. uveitis
The big five for red eye:
1. subconjunctival haemorrhage2. corneal foreign bodies
3. corneal abrasions
4. hyphaema
5. uveitis
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Sub Galeal Haematoma
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chemosis
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subconjunctival haemorrhage
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cornealforeign body
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fluorescein
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WARNING !WARNING !
TTOTTO
topical
anaesthetics
XX
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Chemical burns
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Assault
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periorbital haematoma
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proptosis
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retrobulbar haemorrhage
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surgical empyhsema
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Blowout fractures
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hyphaema
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uveitisposterior synechiae
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DilateDilate
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iridodialysis
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avulsed optic nerve
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optic atrophymacular hole
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commotio retinae
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choroidal tear
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What are signs/symptoms of
trauma that would requireimmediate referral?
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What are signs/symptoms of trauma that
would require immediate referral?
Loss of vision or visual field
Diplopia /Proptosis of the eye
Light flashes or floaters Irregularlyshaped pupil
Red/inflamed eye /FBsensation/embedded foreign body
Hyphema (blood in anterior chamber)
Halos around lights (corneal edema)
Laceration of the lid margin ornear medial canthus
Broken contact lens orshattered eyeglasses glassin eye
Suspected globe perforation
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Trauma: Blunt or penetrating?
Structuresinvolved
Examination of eye
Penetrating ? IOFB When to refer
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3-DAnatomy
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Penetrating wounds: Historyhelpful
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IOFB
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Subconjunctival haemorrhages
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Penetrating
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Lidmargin laceration
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Lidmargin lacerationCarefullyalignto preventnotching
Closetarsal plate withfineabsorbablesuture
Place additional marginal
silksutures
Closeskin withmultiple
interrupted 6-0 blacksilksutures
Align with 6-0 blacksilk
suture
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Canalicular laceration
Repair within 24 hours Locateandapproximateendsoflacerati
Bridgedefect withsiliconetubing
Leavein situ forabout 3 months
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Points on the eyelids
Refer if lid edge isinvolved Ophthalmic or
Plastics
Orbicularis oculi muscle issupplied by the VIIth
cranial nerve and closes the eye
The levator muscle opens the lid (IIIrd nerve)
Blink reflex
Afferent is often Vthnerve
Efferent is VIIth nerve
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The anterior chamber
May contain blood (hyphaema) after trauma
May contain pus (hypopyon) in infections of the eye
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Checking for penetratinginjury
What are important
clues to penetration of
the eye?
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Checking for penetratinginjury
Soft eye
Visual acuity
Red reflex absent
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Corneal and scleral lacerations
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Managementofintraocularforeignbodies
Localization withreferencetoradio-opaquemarker
X ray
CT Scan
B-scan Ultrasound
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Removing IOFBs
Old Electro-magnet
Modern Forceps
and vitrectomy
Complications of penetrating trauma
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Complicationsofpenetratingtrauma
Flatanteriorchamber
Vitreoushaemorrhage
Damageto lensandiris
EndophthalmitisTractional ret
inal
detachment
Uveal prolapse
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Endophthalmitis
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Endophthalmitis
Replicating organismsinside the
eyeball
Often: Staphylococci,Bacillus or
Gram negative bacteria
Pain, red eye,hypopyon, loss of vision
and red reflex