Ophthalmology topic presentation

1. BLUNT TRAUMA

2. CLASSIFICATION OF TRAUMA
EYELID TRAUMA ORBITAL TRAUMA TRAUMA TO GLOBE CHEMICAL INJURIES
-BLUNT TRAUMA
-PENETRATING
TRAUMA
-SUPERFICIAL
FOREIGN BODY
-INTRAOCULAR
FOREIGN BODY
-HAEMATOMA
-LACERATIONS
-FLOOR FRACTURE
-ROOF FRACTURE
-MEDIAL WALL
FRACTURE
-LATERAL WALL
FRACTURE
-HAEMORRHAGE
-ACID
-ALKALI

3. TRAUMA TO GLOBE

4. TERMINOLOGIES
• OPEN GLOBE INJURIES :
-WHEN INFLICTED WITH BLUNT WEAPON- RUPTURES
-WHEN INFLICTED WITH SHARP WEAPON- LACERATION
- LACERATIONS ONE SIDE COATS(PENETRATION)
BOTH SIDE COATS(PERFORATION)
• CLOSED GLOBE INJURIES: GENERALLY FOLLOW BLUNT TRAUMA

5. MODE OF INJURY
• DIRECT INJURY(COUP) TO EYE eg.- BALL, STONES ETC
• INDIRECT(CONTRECOUP)-TRANSMITTED PRESSURE WAVES

6. MECHANISMS CAUSING INJURY

7. CELLULAR PATHOPHYSIOLOGY
• MECHANICAL TRAUMA TO TISSUE
• AVASCULARITY
• NERVE DAMAGE CAUSING TROPHIC CHANGES

8. CLINICAL FEATURES
• EFFECTS CAN BE SEEN ON
-ORBIT
-EYELID
-CONJUNCTIVA
-CORNEA
-SCLERA
-ANTERIOR CHAMBER
-IRIS,PUPIL AND CILIARY BODY
-LENS
-VITREOUS
-CHOROID
-RETINA
-OPTIC NERVE

9. ORBITAL INJURIES
• ORBITAL FRACTURES
-INFERIOR WALL –BLOWOUT FRACTURE
-HAEMORRHAGE

10. EYELID
• ECCHYMOSIS
• BLACK EYE
• TRAUMATIC PTOSIS(DAMAGE TO LEVATOR MUSCLE)

11. CONJUNCTIVA
• SUBCONJUNCTIVAL HAEMORRHAGE

12. CORNEA
CORNEAL
ABRASION
TEARS IN
DESCEMET’S
MEMBRANE/DEEP
CORNEAL OPACITY

13. CORNEAL
BLOOD
STAINING

14. • RECURRENT KERACTALGIA- RECURRENT ACUTE ATTACKS OF PAIN AND
LACRIMATION FOLLOWING FINGERNAIL TRAUMA
TREATMENT:
• PAD AND BANDAGE WITH ANTIBIOTICS FOR SIMPLE TEARS.
• RECURRENT KERACTALGIA: DEBRIDEMENT OF LOOSE
EPITHELIUM FOLLOWED BY PAD AND BANDAGE.
• BLOOD STAINING OF CORNEA: CLEARS ON ITS OWN.
MANGEMENT TOWARDS PREVENTION OF SECONDARY
HAEMORRHAGE AND RAISED IOP.

15. SCLERA/RUPTURED GLOBE

16. • INJURY OCCURING INSIDE OUT
• INFEROTEMPORAL DIRECTION OF FORCE
• WEAKEST POINT OF SCLERA- VICINITY OF CANAL OF SCHLEMM OR
JUST POSTERIOR TO INSERTION OF RECTI
• INJURY MORE OR LESS CONCENTRIC WITH CORNEAL MARGIN ABOUT
3 mm BEHIND IT.
• IRIDODIALYSIS AND LENS DISLOCATION PRESENT, INTRAOCULAR
BLEEDING AND DETATCHED RETINA WITH OR WITHOUT
SUPRACHOROIDAL OR SUBRETINAL HAEMORRHAGE CAN COMPLICATE
TREATMENT
• TREATMENT:
• REPLACEMENT OF PROLAPSED STRUCTURES WITH SUTURING OF
RUPTURE LINE
• IF POSTERIOR TO VITREOUS: CRYOTHERAPY TO PREVENT RETINAL
DETATCHMENT
• VITREORETINAL SURGERY 10-14 DAYS AFTERWARDS
• ANTIBIOTICS(LOCAL+SYSTEMIC) AND STERIODS(TO PREVENT
SYMPATHETIC OPHTHALMITIS

17. ANTERIOR CHAMBER
TRAUMATIC
HYPHEMA
TOTAL
HYPHEMA

18. TREATMENT:
• CONTROL OF SECONDARY HAEMORRHAGE
• MONITOR IOP
SOURCE:
IRIS ROOT
CILIARY BODY FACE

19. IRIS,PUPIL AND CILIARY BODY
VOSSIUS RING
RADIAL SPHINCTER
TEARS
IRIDODIALYSIS

20. • POST TRAUMATIC IRIDOCYCLITIS
• TRAUMATIC MIOSIS/MYDRIASIS
• RUPTURES IN PUPILLARY MARGINS
• IRIDODIALYSIS- ”D” SHAPED PUPIL. SEVERE INJURY CAUSES
ANTEFLEXION OF IRIS
• TRAUMATIC ANIRIDIA/IRIDEREMIA-COMPLETELY TORN AND SINKS TO
THE BOTTOM. SAME CAN BE CAUSED BY RETROFLEXION OF IRIS
• ANGLE RECESSION
TREATMENT:
• ANTI INFLAMMATORY MEDICATIONS GIVEN LOCALLY
• ATROPINE FOR IRIDODIALYSIS

21. LENS
• CONCUSSION CATARACT- “ROSETTE” SHAPED CATARACT. LATE
ROSETTE SHAPED CATARACT 1-2 YEARS AFTER CONCUSSION INJURY
CAN ALSO OCCUR
• DISLOACATION OF LENS:TEARING OF ZONULES BY PRESSURE WAVES
• IRIDODONESIS
• COMPLETE RUPTURE OF SUSENSORY LIGAMENT: DISLOCATION INTO
VITREOUS
• ASTIGMATISM IN CASE OF SUBLUXATION; DIPLOPIA IN CASE OF
DISPLACEMENT

22. FLOWER
SHAPED
CATARACT
DENSE TRAUMATIC
CATARACT WITH
SUBLUXATION
LENS IN
VITREOUS
CAVITY
ANTERIOR
CHAMBER
DISLOCATION

23. • TREATMENT:
• REMOVAL OF LENS WITH IOL IMPLANTATION
• IF LEFT IN VITREOUS, LEAVE IT THERE UNLESS COMPLICATIONS
OCCUR-THEN LENS REMOVAL WITH VITRECTOMY MAY BE NECESSARY

24. VITREOUS
• ANTERIOR AND POSTERIOR DETATCHMENT
• PIGMENT CELLS(TOBACCO DUST) CAN BE SEEN FLOATING AROUND
• HAEMORRHAGE INTO VITREOUS. FUNDUS EXAMINATION-DULL RED
HUE

25. CHOROID
• RUPTURE OF CHOROID, BRUCH’S MEMBRANE, RPE
WHITE APPEARANCE:
SCLERA SHINING
THROUGH

26. RETINA
• COMMOTIO RETINAE/BERLIN’S OEDEMA- CHERRY RED SPOT
• TRAUMATIC MACULAR DEGENERATION
-MACULAR HOLE
• RETINAL BREAKS
• RETINAL HAEMORRHAGES- FLAME SHAPED OR D SHAPED
• RETINAL DETATCHMENT
• RETINITIS PROLIFERANS- SECONDARY TO VITREOUS HAEMORRHAGE

27. COMMOTIO
RETINAE-CLASSIC
COMMOTIO RETINAE-
WITH HAEMORRHAGE

28. MACULAR HOLE

29. EQUATORIAL RETINAL BREAK

30. OPTIC NERVE
• INJURY DUE TO FRACTURE BASE OF SKULL
• AVULSION INJURY DUE TO GUSHOT WOUND
• HAEMORRHAGE AND CONCUSSION INJURY OF THE NERVE AND
SHEATH

32. INTRA OCULAR PRESSURE
• HYPOTONY DUE TO CILIARY BODY SHOCK
• TRAUMATIC GLAUCOMA DUE TO HYPHEMA, GHOST CELL GLAUCOMA
• TREATMENT ALONG MEDICAL AND SURGICAL LINES

33. COMPLICATIONS
• SECONDARY GLAUCOMA
• HAEMOPHTHALMITIS
• LATE ROSETTE CATARACT
• RETINAL DETATCHMENT

34. REFERENCES
• PARSONS TEXTBOOK OF EYE 22ND EDITION
• KANSKI’S CLINICAL OPHTHALMOLOGY 8TH EDITION

35. THANK YOU