Ocular Blunt injury

1. Blunt Injury &
Intraorbital Foreign body
dr. Frenky R. de Jesus
National Eye Centre
Postgraduate diploma in Ophthalmology

2. Blunt Injury & IOFB
dr. Frenky
Modes of injury
Blunt trauma may occur following:
• DIRECT BLOW to the eyeball by fist, ball or blunt instruments like sticks or
big stones.
• ACCIDENTAL BLUNT TRAUMA to eyeball which occurs in roadside
accidents, injuries by agricultural and industrial machines, fall upon a
projecting object.

3. Blunt Injury & IOFB
dr. Frenky
Mechanism of blunt trauma
Compression
Wave force
Reflected
Compression
Wave force
Rebound
Compression
Wave force
Direct
Impact
Maximum damage
at the point where
blow is received.
It is transmitted through fluid contents in all
directions and strikes angle of anterior
chamber, pushes iris diaphragm posteriorly
and also strikes the retina and choroid and
injury may sometimes be countercoup in
nature.
After striking the outer coats the
compression waves are reflected
towards the posterior pole and may
cause FOVEAL damage.
After striking the posterior wall of the globe,
the compression waves rebound back
anteriorly. This force damages the retina,
choroid by forward pull and lens-iris
diaphragm by forward thrust from back.

4. Blunt Injury & IOFB
dr. Frenky
BETTS Injury classification

5. Blunt Injury & IOFB
dr. Frenky
Examinations
- Quick description of patients.
- History taking (Age and occupation, Presenting symptoms, source and mechanism of
injury, time of injury, place of injury, environment of injury).
- Previous ocular history (Vision? Trauma? Surgery? Contact lens use? Medication?)
- Previous medical history (DM, HTN, Arthritis, Bleeding disorder, anticoagulant therapy).
- Visual acuity.
- Ocular movement examination.
- Inspection (Location, proptosis, orbital wall).
- Palpation (Crepitus, tenderness, bone deformities).
- Ocular examination (Cornea, Conjunctiva, Sclera, AC, Iris, Lens, Pupil, Fundos).
- Pediatric (parents, topical anesthesia).
- Globe open injury (GA).

6. Blunt Injury & IOFB
dr. Frenky

7. Blunt Injury & IOFB
dr. Frenky
Clinical Features
CORNEA
Fingernail trauma Corneal abrasion
CONJUNCTIVA
Subconjunctival hemorrhage Conjunctiva laceration

8. Blunt Injury & IOFB
dr. Frenky
SCLERA
Scleral laceration
ANTERIOR CHAMBER
Hyphema Exudates
IRIS, PUPIL AND CILIARY BODY
Rupture pupillary margin Iridodylisis Traumatic mydriasis
Clinical Features

9. Blunt Injury & IOFB
dr. Frenky
Clinical Features
IRIS, PUPIL AND CILIARY BODY
Angle recession Iridocyclitis Traumatic aniridia
Anterior capsule rupture Subluxated lens Traumatic cataract
LENS

10. Blunt Injury & IOFB
dr. Frenky
VITREOUS
Clinical Features
CHOROID
Vitreous hemorrhage PVD Vitreous herniation
Choroidal hemorrhage Choroidal rupture Traumatic chorioretinitis

11. Blunt Injury & IOFB
dr. Frenky
RETINA
Close Globe Injury
Commotio retinae Macular holeRetinal detachment
Traumatic Optic NeuropathyOptic Nerve avulsion Equatorial retinal break

12. Blunt Injury & IOFB
dr. Frenky
Investigations

13. Blunt Injury & IOFB
dr. Frenky
Investigations

14. Blunt Injury & IOFB
dr. Frenky
Investigations

15. Blunt Injury & IOFB
dr. Frenky
Investigations

16. Blunt Injury & IOFB
dr. Frenky
• Cold compress.
• Analgesic.
• Antibiotic.
• Surgery.
Management

17. Blunt Injury & IOFB
dr. Frenky
Intraorbital FB
• An intraorbital foreign body is an important cause of ocular morbidity especially in the
peadiatric and adolescent age groups.
• The term refers to a foreign body that occurs within the orbit but outside the globe.
• Occurs after a high velocity injury: gunshot or an industrial accident.
• More commonly observed in males than in females and in younger than in older
patients.
They can be classified according to their composition into
a) metallic such as steel;
b) nonmetallic.

18. Blunt Injury & IOFB
dr. Frenky
• Foreign body usually enter the orbit in two ways
• High velocity: explosions, bullets, industrial accidents.
• Low velocity: puncture wound, falls.
• Entrance site may be through the globe or periorbital
tissue.
Intraorbital FB

19. Blunt Injury & IOFB
dr. Frenky
• Determine the nature of the foreign body:
• Initial evaluation may include:
• A detail history of the traumatic event (time course of
event, how did the accident happen, source of FB, nature
of the FB).
• A history of the VA prior to the injury.
• VA, Ocular motility, IOP, Pupillary reaction.
Examinations

20. Blunt Injury & IOFB
dr. Frenky
Clinical Features
• Early findings
• Symptoms of the orbital FB
• Orbital Mass
• Decreased of ocular motility
• Proptosis.
• Orbital hemorrhage
• Decreased vision .
• Pain on eye movement.
• Late findings
• Persistent orbital edema.
• Orbital mass
• Optic neuropathy.
• Orbital cellulitis
• Orbital absces.
• Orbital pain.
• Orbital-cutaneos fistula.

21. Blunt Injury & IOFB
dr. Frenky

22. Blunt Injury & IOFB
dr. Frenky
Assesment
• Don’t remove in ER unless superficial.
• Evaluate for globe rupture.
• Explore the depth of wound for superficial FB.
• Metallic and Non-Organic materials.
• Leave in the orbit if: (Inner, small, smooth, imbedded in fat, law
infectious risk, posterior location).
• Consider removing the FB if: (Toxic, organic, sharp, large, high
infectious risk, anterior location, intracranial extension, cellulitis or
abscess).

23. Blunt Injury & IOFB
dr. Frenky
Investigations
• Plain Xray

24. Blunt Injury & IOFB
dr. Frenky
Investigations
• Plain Xray & CT-Scan

25. Blunt Injury & IOFB
dr. Frenky
• Fundos & CT-Scan
Investigations

26. Blunt Injury & IOFB
dr. Frenky
Investigations

27. Blunt Injury & IOFB
dr. Frenky
Management
• Start antibiotic (Late generation Cephalosporin and
aminoglucosydes).
• If wood or vegetables matter cover with anaerobic.
• Tetanus prophylaxis.

28. Blunt Injury & IOFB
dr. Frenky
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