Refractive and Adnexa Conditions That Can Be Caused by Trauma

Traumatic myopia Transient myopia that can occur after blunt ocular trauma Traumatic myopia tends to resolve without treatmentPeriorbital ecchymosis "black eye," blood accumulation in the eyelids,more noticeable in the lower lid , forms an organized hematoma or firm purplish-black mass

Treatmentcold compress intermittently for the first 48 hours, followed by hot packs for 3 to 5 days thereafter

Eyelid lacerations Superficial lacerations : clean the wound, irrigate, remove any foreign material, apply AB ointment and sterile dressingDeeper lacerations : suturesComplicated lacerations : oculoplastics consult

Anterior Segment Conditions That Can Be Caused by Trauma

Subconjunctival hemorrhages do not require treatment, resolve in 1 to 2 weeks

Conjunctival abrasions -Produce fluorescein staining, subconjunctival hemorrhage-AB eo TID for 4 to 7 days, pressure patching for 24 hours -Suturing, heal without surgical repair

Corneal and conjunctival foreign bodies asymptomatic, mild to moderate eye paininspect the fornices thoroughly and evert the eyelids

Corneal abrasions Seidel test -History of rubbing or scraping the cornea TreatmentSmall to moderately: fairly tight-fitting bandage lens + AB Large abrasions : pressure patch + ABCycloplegics and analgesic

Corneal lacerationCutting or tearing the cornea Seidel test can be crucial Partial-thickness : treat like a corneal abrasion Moderate to deep :suturing Full-thickness: treat like a ruptured globe Moderate and Full - Ophthalmologist

Chemical burns Affect multiple ocular structures,potentially cause blindness Alkaline : hydrophilic and lipophilic rapidly penetrate cell membranes saponification,cell death disruption of the extracellular matrix

Acidic : less damage , coagulated tissue

Whiter eyes are more alarming then red eyes Management :begin irrigation as soon as possiblecycloplegic, AB eo, artificial tears, steroid topical, oralVit C , Diamox, pressure, amnion membran

Hyphema

Layering of RBCs in the inferior anterior chamber Management : Hospitalization during the most critical time for clot formation; about 5 to 7 days after the injury. Discontinuing elective anticoagulants Patient's head should be elevated 30 Antifibrinolytic agent, steroids Surgical evacuation of the clot

Complication3.5 to 38% of patients rebleed, 2 to 5 days after about 30% have temporarily elevated IOP for 5 to 7 days5% require surgical interventionabout 75% demonstrate some degree of angle recession or iridodialysisonly 5% will develop secondary glaucoma.

Hemosiderosiscornea becomes stained by blood prolonged hyphemaelevated IOPendothelial damage

Iridodialysis Detachment of the iris root from the ciliary body Produce corectopia (irregular pupil shape), pseudo polycoria, and diplopia Monitor for glaucoma Treatment :opaque soft contact lens with a clear pupil

Traumatic cataract

Lens subluxation

Anterior Lens Dislocation

Posterior Lens Dislocation

Globe And Orbit Conditions That Can Be Caused By Trauma

Intraorbital foreign bodyHigh-velocity periocular injuries Inorganic IOrbFBs and OrganicAnti-tetanus prophylaxis and a broad-spectrum oral antibiotic Surgical removal is indicated

Intra Orbital Foreign Body

Globe RuptureGlobe ruptureThe signs Severe subconjunctival hemorrhage Deep or shallow anterior chamber, hyphema, irregularly shaped pupil , exposed uveal tissue (appears brownish-red), an EOM restriction ,hypotonyManagementSuture, Eviseration

Globe Rupture

Retrobulbar hemorrhage Orbital vessel ruptures and leaks blood products into the orbit

The sign non-pulsating exophthalmos resistance to retropulsion, elevated IOPEOM restriction, central retinal artery pulsation, choroidal folds, and possibly optic neuropathy Treatment Decrease IOP Immediate surgical lateral canthotomy and cantholysis to reduce orbital pressure Orbital decompression

Arteriovenous fistulas High-flow fistulas : traumatic basal skull fracture The Signsaudible orbital bruit, pulsatile proptosis, chemosis, orbital swelling, elevated IOP, ophthalmoplegia, and retinal vessel congestion

Low-flow fistulaInsidious onset , not usually caused by trauma associated with hypertension , arteriosclerosisThe signsMild orbital congestion , proptosis, low or no orbital bruit, and normal to elevated IOP.

Low-Flow Arteriovenous fistula

Orbital fractures Common cause:Blunt trauma The signsCrepitus or subcutaneous emphysemaMuscle entrapment and/or a nerve palsy , decrease facial sensitivity

Vitreous And Retinal Conditions That Can Be Caused By TraumaIntraocular foreign body

Commotio retinae / Berlins Edema

Pre-retinal hemorrhage

Choroidal rupture

Traumatic macular hole

Purtscher's retinopathy

Traumatic Retinal detachmentTraumatic retinal detachment

Traumatic optic neuropathy

Optic nerve avulsion

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