Ocular trauma
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Ocular trauma

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Ocular trauma Ocular trauma Presentation Transcript

  • OCULAR TRAUMA
  • Mechanical Injuries Closed Globe Injuries Open Globe Injuries Contusion Lamellar Laceration Superficial foreign body Laceration Rupture Penetrating injury Perforating Injury Intraocular foreign body OCULAR TRAUMA CLASSIFICATION GROUP
  • Concussion Injury
    • Coup or direct injury
    • Contre-coup or distant damage
  • CORNEA
    • Foreign body – removed under topical anaesthesia
    • Abrasion – patching
    • Descemet membrane rupture – forceps delivery
    • Blood staining of cornea – hyphaema with IOP
      • Reddish-brown or greenish
      • Simulates anterior dislocation of clear lens
      • Derivates of Hb in deep stromal corpuscles
      • Clears from periphery to centre
      • Usually permanent
  • SCLERA
    • Globe rupture
    • Force from inferotemporal direction
      • Neighborhood of canal of Schlemm
      • Posterior to insertion of recti
    • Wound runs outwards and backwards concentric to limbus 3mm behind
    • Iris prolapse, hyphaema, retinal detachment, vitreous hemorrhage
    • Treatment – sutured with 8-0 ethicon with or without cryotherapy
  • Iris and Ciliary body
    • Traumatic iridocyclitis
    • Traumatic miosis
    • Traumatic mydriasis
    • Sphincter tear
    • Iridodialysis
      • D shaped pupil
      • Uniocular diplopia
    • Traumatic aniridia or irideremia
  • Iris and ciliary body
    • Angle recession
      • Rupture of anterior part of ciliary body
      • Tear between circular and longitudinal fibres
      • Hyphaema
      • Late onset glaucoma
    • Traumatic hyphaema
      • Asso with angle recession/iridodialysis/cyclodialysis
      • IOP assesment
      • Re-bleeding
      • Level of hyphaema
  • Lens
    • Vossius ring – iris imprint on anterior lens capsule
    • Concussion injury
      • Mechanical damage to lens fibres
      • Capsular tear
        • Peripheral / Thinnest portion
      • Rosette shaped cataract
        • Star shaped cortical sutures are delineated
        • Feathery lines of opacities radiate from them
      • Rapid intumescence of lens with secondary glaucoma
    • Dislocation
    • Subluxation
  • Vitreous
    • Detachment
    • Hemorrhage
    • Liquefaction of vitreous
    • Choroid
    • Rupture – concentric to disc usually temporal to it
      • Whitish crescent with fine pigmentation at its margin
    • Choroidal hemorrhage
    • Choroidal detachment
  • Retina
    • Commotio retinae (Berlin’s edema)
      • Milky white cloudiness of posterior pole
      • Cherry red spot at fovea
    • Retinal hemorrhages
    • Retinal tears
    • Retinal detachment
    • Traumatic retinitis proliferans
    • Traumatic macular degeneration
    • Macular hole
  • Chemical injury
    • Alkalis
      • Lime
      • Whitewash
      • Fresh mortar
    • Surface epithelium necrosed
    • Penetrates the cornea
    • Occludes limbal vasculature
      • Corneal opacity
      • Melting cataract
      • Symblepharon
    • Acids
      • Sulphuric acid
      • Hydrochloric acid
    • Necrosis of conj
    • Symblepharon
    • Acids cause coagulation of proteins preventing deeper penetration
    • Corneal melting and opacity
  • Chemical injury
    • Severity depends on strength and duration of contact
    • Grade I (mild) no limbal ischemia
    • Grade II (moderate) <180deg limbal ischemia
    • epithelial defect with clear cornea
    • Grade III (severe) >180deg limbal ischemia
    • epithelial defect with hazy cornea
    • Grade IV (severe) >270deg limbal ischemia
    • epithelial defect and hazy cornea
  • Chemical injury - treatment
    • Saline wash for 30min or until pH is normal
    • Particles of lime removed with forceps
    • Topical antibiotic drops
    • Cycloplegics
    • Topical steroids – reduces inflammation
    • Acetazolamide tablet if IOP is raised
    • Ascorbic acid oral and topical
    • Glass rod sweeping to prevent symblepharon
    • Bandage contact lens for epithelial healing
    • Lubricants