AHMED FOUAD MAHMOUDAHMED FOUAD MAHMOUDOPHTHALMOLOGISTOPHTHALMOLOGIST

MGHMGH

OCULAR TRAUMA

History-Questions to askHistory-Questions to ask Onset, durationOnset, duration Patient’s occupationPatient’s occupation Exposure to Exposure to

chemicals, UV light, chemicals, UV light, cosmetics, etccosmetics, etc

Trauma, foreign Trauma, foreign body, contact lensbody, contact lens

Type of painType of pain PhotophobiaPhotophobia

Exudate?Exudate? Systemic symptoms- Systemic symptoms-

fever, N/V, rash, fever, N/V, rash, arthritisarthritis

Past medical history- Past medical history- DM, HIV, collagen DM, HIV, collagen vasc disease, HTN, vasc disease, HTN, glaucoma, eye glaucoma, eye surgerysurgery

EXTERNAL EYEEXTERNAL EYEExamine periorbital skin Examine periorbital skin and lids forand lids for: :

TraumaTraumaInfectionInfection DysfunctionDysfunction DeformityDeformity CrepitusCrepitusProptosisProptosis Subcutaneous emphysema Subcutaneous emphysema

FOREIGN OBJECTSFOREIGN OBJECTS

dustdust dirtdirt metalmetal splintersplinter rustrust pens/pencilspens/pencils glass, etc. glass, etc.

TREATMENTTREATMENTFOREIGN OBJECTSFOREIGN OBJECTS

DO NOT rub the eyeDO NOT rub the eye flush eye with tepid water from inner flush eye with tepid water from inner

corner to outer corner of eye until corner to outer corner of eye until object is free object is free (use gentle water flow)(use gentle water flow)

may invert eyelid onto Q-tip, and may invert eyelid onto Q-tip, and gently flush object gently flush object

if still in, close both eyes & seek if still in, close both eyes & seek medical attentionmedical attention

keep patient informed as they can’t keep patient informed as they can’t seesee

EYE INJURIESEYE INJURIES

CAUSES OF BLUNT CAUSES OF BLUNT EYE TRAUMA:EYE TRAUMA: fists (altercations)fists (altercations) snowballssnowballs baseballs/softballsbaseballs/softballs doors, etc. doors, etc.

Orbital Wall FractureOrbital Wall Fracture

algorithm

Vitreous HemorrhageVitreous Hemorrhage

Retinal HemorrhageRetinal Hemorrhage

Optic Disc HemorrhageOptic Disc Hemorrhage

TREATMENTTREATMENTBLUNT EYE TRUAMABLUNT EYE TRUAMA

have victim sit semi-upright have victim sit semi-upright close both eyesclose both eyes seek medical attention seek medical attention

immediatelyimmediately

DODO NOTNOT place any weight onto place any weight onto globe of eyeglobe of eye

DODO NOTNOT place ice on the eye place ice on the eye

PENETRATING PENETRATING EYE INJURIESEYE INJURIES

CAUSES :CAUSES : penspens ice picksice picks knivesknives bulletsbullets roofing staplesroofing staples pool sticks, etc. pool sticks, etc.

staple

TREATMENTTREATMENTPENETRATING EYEPENETRATING EYE

place victim in place victim in semi-sitting semi-sitting positionposition

close close both eyes both eyes of victimof victim NO pressureNO pressure on the eye on the eye dry gauze pads over both eyesdry gauze pads over both eyes seek medical attention seek medical attention

immediately immediately victim victim can’t see can’t see when both eyes when both eyes

are covered, keep them informedare covered, keep them informed

CHEMICAL BURNSCHEMICAL BURNS Acid Acid

destroys eye destroys eye within 30 min. & within 30 min. & appears appears “beefy “beefy red”red”

flush immediately flush immediately with tepid, gentle with tepid, gentle flow water, from flow water, from inner to outer inner to outer corner of eye 20 corner of eye 20 minutes minimum minutes minimum

AlkaliAlkali destroys eye in destroys eye in

30 seconds & 30 seconds & appears appears “milky “milky white”white”

flush immediately flush immediately with tepid, gentle with tepid, gentle flow water, from flow water, from inner to outer inner to outer corner of eye 20 corner of eye 20 minutes minimumminutes minimum