Ocular trauma

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Ocular trauma

  1. 1. OCULAR TRAUMA
  2. 2. 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
  3. 3. Concussion Injury <ul><li>Coup or direct injury </li></ul><ul><li>Contre-coup or distant damage </li></ul>
  4. 4. CORNEA <ul><li>Foreign body – removed under topical anaesthesia </li></ul><ul><li>Abrasion – patching </li></ul><ul><li>Descemet membrane rupture – forceps delivery </li></ul><ul><li>Blood staining of cornea – hyphaema with IOP </li></ul><ul><ul><li>Reddish-brown or greenish </li></ul></ul><ul><ul><li>Simulates anterior dislocation of clear lens </li></ul></ul><ul><ul><li>Derivates of Hb in deep stromal corpuscles </li></ul></ul><ul><ul><li>Clears from periphery to centre </li></ul></ul><ul><ul><li>Usually permanent </li></ul></ul>
  5. 5. SCLERA <ul><li>Globe rupture </li></ul><ul><li>Force from inferotemporal direction </li></ul><ul><ul><li>Neighborhood of canal of Schlemm </li></ul></ul><ul><ul><li>Posterior to insertion of recti </li></ul></ul><ul><li>Wound runs outwards and backwards concentric to limbus 3mm behind </li></ul><ul><li>Iris prolapse, hyphaema, retinal detachment, vitreous hemorrhage </li></ul><ul><li>Treatment – sutured with 8-0 ethicon with or without cryotherapy </li></ul>
  6. 6. Iris and Ciliary body <ul><li>Traumatic iridocyclitis </li></ul><ul><li>Traumatic miosis </li></ul><ul><li>Traumatic mydriasis </li></ul><ul><li>Sphincter tear </li></ul><ul><li>Iridodialysis </li></ul><ul><ul><li>D shaped pupil </li></ul></ul><ul><ul><li>Uniocular diplopia </li></ul></ul><ul><li>Traumatic aniridia or irideremia </li></ul>
  7. 7. Iris and ciliary body <ul><li>Angle recession </li></ul><ul><ul><li>Rupture of anterior part of ciliary body </li></ul></ul><ul><ul><li>Tear between circular and longitudinal fibres </li></ul></ul><ul><ul><li>Hyphaema </li></ul></ul><ul><ul><li>Late onset glaucoma </li></ul></ul><ul><li>Traumatic hyphaema </li></ul><ul><ul><li>Asso with angle recession/iridodialysis/cyclodialysis </li></ul></ul><ul><ul><li>IOP assesment </li></ul></ul><ul><ul><li>Re-bleeding </li></ul></ul><ul><ul><li>Level of hyphaema </li></ul></ul>
  8. 8. Lens <ul><li>Vossius ring – iris imprint on anterior lens capsule </li></ul><ul><li>Concussion injury </li></ul><ul><ul><li>Mechanical damage to lens fibres </li></ul></ul><ul><ul><li>Capsular tear </li></ul></ul><ul><ul><ul><li>Peripheral / Thinnest portion </li></ul></ul></ul><ul><ul><li>Rosette shaped cataract </li></ul></ul><ul><ul><ul><li>Star shaped cortical sutures are delineated </li></ul></ul></ul><ul><ul><ul><li>Feathery lines of opacities radiate from them </li></ul></ul></ul><ul><ul><li>Rapid intumescence of lens with secondary glaucoma </li></ul></ul><ul><li>Dislocation </li></ul><ul><li>Subluxation </li></ul>
  9. 9. Vitreous <ul><li>Detachment </li></ul><ul><li>Hemorrhage </li></ul><ul><li>Liquefaction of vitreous </li></ul><ul><li>Choroid </li></ul><ul><li>Rupture – concentric to disc usually temporal to it </li></ul><ul><ul><li>Whitish crescent with fine pigmentation at its margin </li></ul></ul><ul><li>Choroidal hemorrhage </li></ul><ul><li>Choroidal detachment </li></ul>
  10. 10. Retina <ul><li>Commotio retinae (Berlin’s edema) </li></ul><ul><ul><li>Milky white cloudiness of posterior pole </li></ul></ul><ul><ul><li>Cherry red spot at fovea </li></ul></ul><ul><li>Retinal hemorrhages </li></ul><ul><li>Retinal tears </li></ul><ul><li>Retinal detachment </li></ul><ul><li>Traumatic retinitis proliferans </li></ul><ul><li>Traumatic macular degeneration </li></ul><ul><li>Macular hole </li></ul>
  11. 11. Chemical injury <ul><li>Alkalis </li></ul><ul><ul><li>Lime </li></ul></ul><ul><ul><li>Whitewash </li></ul></ul><ul><ul><li>Fresh mortar </li></ul></ul><ul><li>Surface epithelium necrosed </li></ul><ul><li>Penetrates the cornea </li></ul><ul><li>Occludes limbal vasculature </li></ul><ul><ul><li>Corneal opacity </li></ul></ul><ul><ul><li>Melting cataract </li></ul></ul><ul><ul><li>Symblepharon </li></ul></ul><ul><li>Acids </li></ul><ul><ul><li>Sulphuric acid </li></ul></ul><ul><ul><li>Hydrochloric acid </li></ul></ul><ul><li>Necrosis of conj </li></ul><ul><li>Symblepharon </li></ul><ul><li>Acids cause coagulation of proteins preventing deeper penetration </li></ul><ul><li>Corneal melting and opacity </li></ul>
  12. 12. Chemical injury <ul><li>Severity depends on strength and duration of contact </li></ul><ul><li>Grade I (mild) no limbal ischemia </li></ul><ul><li>Grade II (moderate) <180deg limbal ischemia </li></ul><ul><li>epithelial defect with clear cornea </li></ul><ul><li>Grade III (severe) >180deg limbal ischemia </li></ul><ul><li>epithelial defect with hazy cornea </li></ul><ul><li>Grade IV (severe) >270deg limbal ischemia </li></ul><ul><li>epithelial defect and hazy cornea </li></ul>
  13. 13. Chemical injury - treatment <ul><li>Saline wash for 30min or until pH is normal </li></ul><ul><li>Particles of lime removed with forceps </li></ul><ul><li>Topical antibiotic drops </li></ul><ul><li>Cycloplegics </li></ul><ul><li>Topical steroids – reduces inflammation </li></ul><ul><li>Acetazolamide tablet if IOP is raised </li></ul><ul><li>Ascorbic acid oral and topical </li></ul><ul><li>Glass rod sweeping to prevent symblepharon </li></ul><ul><li>Bandage contact lens for epithelial healing </li></ul><ul><li>Lubricants </li></ul>

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