Lecture Lecture 55

OCULAR OCULAR INJURYINJURY

Lecture is delivered byLecture is delivered byPh. D., assistant of professor Tabalyuk Tetyana Ph. D., assistant of professor Tabalyuk Tetyana

AnatolyivnaAnatolyivna

Classification of ocular injuryClassification of ocular injury

By conditionsBy conditions:: agricultural, industrial, military, agricultural, industrial, military, criminal etc.criminal etc.

By traumatic factorBy traumatic factor:: mechanical, termal, chemical, radial, biological etc.

By mechanismBy mechanism:: A. blunt injuries (contusions) – lid blunt injuries (contusions) – lid injuries,injuries, orbital injuries, blunt injuries of the orbital injuries, blunt injuries of the eyeballeyeball;;

B.B. penetrating trauma – corneal, limbal, scleral, penetrating trauma – corneal, limbal, scleral, corneo-scleralcorneo-scleral;;

C.C. burnsburns..

BLUNT INJURIES (contusions):

lid injuries: haematoma, laceration;

orbital injuries (fractures);

blunt injuries of the eyeball: corneal abrasion, scleral rupture, iridodyalisis, hyphaema, traumatic mydriasis, lens dislocation, haemophthalmos, commotio retinae, choroidal rupture, choroidoretinal haemorrhage, retinal detachment

A small piece of iron has lodged A small piece of iron has lodged

near the margin of the corneanear the margin of the cornea

IridodyalisisIridodyalisis

leftleft - - subconjunctival haemorrhage; subconjunctival haemorrhage; rightright - b - blood behind lood behind the cornea, inside the eyethe cornea, inside the eye (hyphaema), t (hyphaema), the iris has been he iris has been

bleedingbleeding

HyphaemaHyphaema – blood in the anterior – blood in the anterior chamberchamber

Emergency in blunt injuries:

In corneal abrasion – antibacterial drops and ointments and medicines, which rapid corneal regeneration, for example, Tobramycini, Chinini hydrochloride 1% (2 drops into affected eye 4-6 times a day), Ung.”Floxali” and Corneregel (under lower eyelid 2-3 times a day).

In hyphaema & haemophthalmos – haemostatic therapy, for example S. Dicinoni 12,5 % 2,0 i/m 2 times a day, Tab. ”Ascorutini” per os 3 times a day, ”Vikasoli” 0,015 per os 3 times a day, Sol. Ca chloridi 3 % in drops 4 times a day.

Foreign body of conjunctiva is removed by wet cotton, pincet or injection needle. After removing, antiseptics are instillated and prescribed, for example S.Sulfacili Na or S. Oftadec 4 times a day during 5-7 days.

Corneal foreign body is removed after anaesthesia (S. Alcaini) by injection needle. Antibacterial drops and ointments and medicines, which rapid corneal regeneration are dropped and prescribed, for example, S. Gentamycini 0,3 %, S. Taufoni 4 % (2 drops into affected eye 4-6 times a day), Ung.Tetracyclini and Actovegin gel (under lower eyelid 2-3 times a day).

RETINAL DETACHMENT

1. Rhegmatogenous2. Exudative3. Tractional

Signs of detachment – photopsia, metamorphopsia, “shadow” before eye, peripheral visual field loss controposite the localization of detached retina

Surgical management: Transscleral photocoagulation or criopexy Scleral buckling procedures Vitrectomy & intraocular silicon oil or gas

tamponade

Absolute signs of penetrating injury:

corneal or scleral wound;intraocular foreign body;extrusion of intraocular tissues (iris, choroid, vitreous, lens, etc) through the wound

Relative signs of penetrating injury:

hypotonia;pupil deformation;changing of anterior chamber depth (flat or deep).

Eye injury by impact of small plastic Eye injury by impact of small plastic

bodybody

Open eye injury, with iris prolapsed Open eye injury, with iris prolapsed through the cornea laceration. This through the cornea laceration. This type of injury needs immediate eye type of injury needs immediate eye care attentioncare attention

.

Methods of localization of intraocular foreign body:X-ray examination (metal foreign body - with special

protesis of Komberg-Baltin; nonmetal (glass) –X-ray examination by Fogt)

Ultrasound examination;

Complications of penetrating injury:traumatic cataract;traumatic iridocyclitis;endophthalmitis;panophthalmitis;sympathetic ophthalmia (chronic fibro-plastic autoimmune iridocyclitis of the unaffected eye)

Emergency in eye penetrating injury cleaning the wound,using antiseptics locally (i.e. S. Furacilini 1: 5000 or S. Laevomycetini 0,25 %),analgetics (S. Analgini 50 % 2,0 i/m),antibiotics systemically (i.e.Tab. Ofloxacini 0,2 per os or S. Gentamycini sulfatis 4 % 1,0 i/m),binocular dressing,transportation the patient in horizontal position into the special department

CLASSIFICATION of BURNS

I degree – hyperemia of conjunctiva; superficial opacity of cornea or corneal abrasion which disappears without any changes II degree – superficial necrosis of conjunctiva gray & cloudy cornea (defect of epithelium & superficial layers of stroma)III degree – necrosis of hole conjunctiva defect of all corneal layers – “mat” corneaIV degree – necrosis not only of conjunctiva, but also sclera “porcelain” cornea

Emergency in eye burns

removing of foreign pieces especially in case of lime’s burn, watering of the eye by water, Sol. Na isotonici or S. Furacilini during 15-30 minutes, using of antiseptics or antibiotics in drops (S. Dimexidi 10 %, ”Ciloxan” or ”Tobrex”)