OCULAR INJURIES- An introduction & nomenclature22.11.2013

Ayesha S Abdullah

Learning outcomes By the end of this lecture the students

would be able to Describe the epidemiology of ocular

injuries Classify globe injuries according to the

Birmingham Eye Trauma Terminology (BETT) system of classification

Differentiate between OGI and CGI

How common is it? Trauma is the commonest cause of

ocular emergencies reported in trauma centres

A total of 1.6 million cases of blindness are caused by eye injures

Some 2.3 million cases with low vision are due to ocular injuries

Some 19 million cases of mono ocular blindness are due to eye injuries

Risk factors Gender , any guess? 3:1 male to female ratio Rural areas Compromised socioeconomic status Illiteracy Conflicts

Classification According to vector (The Agent) According to settings (Place of injury) According to pathology (Effects produced) According to anatomical structures

involved According to severity (Damage produced)

According to the site involved Orbital trauma Superficial & corneal foreign bodies Lid injuries Globe injuries

Nature of injurious agent

Mechanical Injuries

Chemical Injuries Acid AlkaliOthers

Radiation Injuries

Thermal Injuries

Electrical Injuries

Place of Injury

Home School Playground Agriculture Industry Laboratory Workshops Assault/ combat

Birmingham Eye Trauma Terminology System (BETTS)

Trauma to the

Globe

http://www.asotonline.org/bett.html

Definitions -BETTS Closed Injury in which cornea & sclera are intact but there is intraocular damage. Open Injury is associated with full-thickness wound of cornea or sclera or both. Rupture is a full-thickness wound caused by blunt trauma Laceration is full-thickness injury caused by a sharp

object Penetration is caused by a single laceration with a

sharp object Perforation consists of two lacerations, one entry and

one exit

http://www.asotonline.org/bett.html http://bestpractice.bmj.com/best-practice/monograph/961/basics/classification.html

Orbital trauma Blow out floor fracture, medial wall, floor,

roof Contusion injury Lacerations Orbital haematoma

Eye Lids Contusion Hematoma Lacerations

Beware of the blood

loss especially in children

Late Complications

Effects of close globe injury (CGI) Mechanism

AP compression Expansion in the equatorial plan Transient & excessive increase in IOP Impact is primarily absorbed by ??

Lens –Iris diaphragm & vitreous The damage can happen in any tissue commonly has long-term effects/ sequelae

Close Globe Injuries

Subconjunctival Haemorrhage Corneal abrasion Acute corneal oedema Traumatic iritis Traumatic Mydriasis / Miosis Hyphaema Iridodialysis Cyclodialysis / Angle recession Ciliary shock

Close Globe Injuries

Subluxation and dislocation of lens Cataract Posterior vitreous detachemet Vitreous haemorrhage Choroidal rupture Commotio retinae Retinal Breaks

Dialysis Equatorial tears Macular holes

Optic nerve avulsion

Home workList three recommendations for the

following Primary Secondary Tertiary prevention of ocular traumaThree power point slides with three points

on each slide send atmsqheartline@hotmail.com with your

name and role number