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Blunt trauma
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- 2. CLASSIFICATION OF TRAUMA EYELIDTRAUMA 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
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- 4. TERMINOLOGIES • OPEN GLOBEINJURIES : -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
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- 7. CELLULAR PATHOPHYSIOLOGY • MECHANICALTRAUMA TO TISSUE • AVASCULARITY • NERVE DAMAGE CAUSING TROPHIC CHANGES
- 8. CLINICAL FEATURES • EFFECTSCAN BE SEEN ON -ORBIT -EYELID -CONJUNCTIVA -CORNEA -SCLERA -ANTERIOR CHAMBER -IRIS,PUPIL AND CILIARY BODY -LENS -VITREOUS -CHOROID -RETINA -OPTIC NERVE
- 9. ORBITAL INJURIES • ORBITALFRACTURES -INFERIOR WALL –BLOWOUT FRACTURE -HAEMORRHAGE
- 10. EYELID • ECCHYMOSIS • BLACKEYE • TRAUMATIC PTOSIS(DAMAGE TO LEVATOR MUSCLE)
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- 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.
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- 16. • INJURY OCCURINGINSIDE 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
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- 18. TREATMENT: • CONTROL OFSECONDARY HAEMORRHAGE • MONITOR IOP SOURCE: IRIS ROOT CILIARY BODY FACE
- 19. IRIS,PUPIL AND CILIARYBODY VOSSIUS RING RADIAL SPHINCTER TEARS IRIDODIALYSIS
- 20. • POST TRAUMATICIRIDOCYCLITIS • 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 LENSIN VITREOUS CAVITY ANTERIOR CHAMBER DISLOCATION
- 23. • TREATMENT: • REMOVALOF 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 ANDPOSTERIOR DETATCHMENT • PIGMENT CELLS(TOBACCO DUST) CAN BE SEEN FLOATING AROUND • HAEMORRHAGE INTO VITREOUS. FUNDUS EXAMINATION-DULL RED HUE
- 25. CHOROID • RUPTURE OFCHOROID, BRUCH’S MEMBRANE, RPE WHITE APPEARANCE: SCLERA SHINING THROUGH
- 26. RETINA • COMMOTIO RETINAE/BERLIN’SOEDEMA- 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
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- 30. OPTIC NERVE • INJURYDUE 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 TEXTBOOKOF EYE 22ND EDITION • KANSKI’S CLINICAL OPHTHALMOLOGY 8TH EDITION
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