Eye assessment in polytrauma for undergraduates.

1. Eye assessment in Poly
trauma
Mohamed ELShafie
Lecturer of ophthalmology

2. The eye protected from direct
injury by:
1-lid
2- lashes
3- margin of the orbit.

3. The most important points about ocular trauma:
Number one of ocular emergencies
Leading cause of blindness , irrespective of age , sex and
geographic distribution.
Male young middle ages is the most common age affected.
Everyone must know the importance of immediate
intervention.
prophylactic better than management.

4. Classification of ocular trauma
Etiological classification
According to the nature of traumas.

5. Classification of ocular trauma according to nature:
• Sharp trauma
• Blunt trauma.
1-Physical (mechanical) trauma:
• Acid
• Alkali
• Dye ( salt of acid and alkali).
2-Chemical trauma:
• Heat
• Cold
3-Thermal
• Ionizing agent.
• Ultraviolet rays.
• Laser burn.
4-Radiation trauma:
5-micellenious.

6. Blunt trauma

8. Take a step back
and
Assess the whole patient

9. Significant eye injury was statistically
associated with the following:
• driving a motor vehicle
• age < 50 years
• male sex
• associated basal skull or orbital fracture
• lid laceration or superficial eye injury.

10. Transfer immediately to ER if:
• unstable vital signs
• impaired mental status
• serious nonocular injuries

11. Try to protect
the eyes
during manipulations of
the mouth, nose, and
trachea.

13. b
C
c
self-limiting condition.
1ST
Periocular
haematoma

14. b
C
c
Lid Laceration
2nd
careful exploration of
the wound.

16. Lacrimal Duct Laceration
• Repair
• Probing with silicon tube and
suturing

18. b
C
c
Self limiting
Sub conjunctival
hemorrhage
3rd

19. b
C
c
Removal under
slit lamp
Foreign body
4TH

20. Intra ocular foreign body
Intra lenticular FB In the angle Anterior vitreous FB Intraretinal FB

21. b
C
c
Healing 1-4 days
5TH
Corneal
Abrasion

22. b
C
c
Chemical Burn
6TH
Alkali burns more severe as it penetrates more deeply into the ocular tissues.
Acids (ammonia and sodium hydroxide) coagulate proteins, forming a protective barrier.

23. •Alkali (OH): cause liquefactive necrosis and more penetrating in
further than acid .
•Acid (H): cause coagulative necrosis so no further penetration.

24. Symptoms:
Pain .
Lacrimation.
Photophobia.
Blepharospasm.
Diminution of vision.
Signs:
Lid edema.
Chemosis.
Corneal aberration.

25. •Medical management
1-Copious irrigation with isotonic saline.
2-Removal of chemical injury particles from corneal , conj. And fornices.
3-topical corticosteroid
•Prednisolone acetate every 2h in mild cases , hourly in severe cases.
•Tapering when healing occur.
•Stop with corneal thinning or melting.
4- topical citrate 10 % .
5-Topical ascorbate .
6-Tab doxy 100 mg bd for 2 weeks
7-Moxifloxacin e/d.
8-Cycloplegic homatropine 2% bid.
•Surgical management :
1- detriments
2-Amminiotic membrane
3-Tissue adhesive and keratoplasty
Treatment:
irrigation, irrigation,
irrigation

26. Irrigation and removal of chemical injury particle :
•Is the most important step in preventing further damage of the
eye must started at the scene of the accident.
•Copious irrigation by:
Normal saline.
Ringer lactate solution.
Clean water.
Any clean fluid.
•Irrigation for 30 min reduce the injury 1.5 unit
• be sure there is no any remanent particle in the fornices which
may hidden in the upper tarsus and convert to alkali by tear and
cause further damage.

29. b
C
c
Repair
Corneal perforation
7th

30. b
C
c
Complications:
elevation of IOP
and re-bleeding
Hyphema
8TH

33. Orbital Wall
Fracture
Blow out medial wall fracture.
Blow out floor fracture.
Lateral wall fracture .
Roof fracture.

34. •Blow out orbital floor fracture:
•Caused by sudden increase of
intraorbital pressure by impacting
object (Ex fist and tennis ball)
greater in diameter than orbital
aperture (more than 5 cm )

35. Blow-out fracture
Restricted elevation
Mild enophthalmos
blow-out fracture of orbital floor Subcutaneous emphysema

36. •CT is the imaging of choice

38. Iris trauma
Vossius circle Rupture sphincter papillae Iridodialysis

40. Lens complication
Traumatic cataract Subluxation of the lens Dislocation of the lens

42. Commotio retina
peripheral
Involving the macula Macular hole after resolving

43. Retinal break and detachment
Retinal dialysis with avulsion
of retinal base Macular hole
Equatorial break

46. Thank you !!

47. Repair of lid laceration:
•General principle:
•Clean the wound.
• Removal of foreign body
• Careful handling of the tissue.
•Careful alignment of the
anatomy.( lid margin . Hair lashes
and skin folds).
•Close in layer
•Anesthesia under general or
local anesthesia.
•Timing perfect within 12 to 24 h
may delayed to one week due to
severe edema of the tissue or
patient factor.

48. •Without gaping :
•primary closure by 5-0 or 6-0 black silk removal after 5 days .
•Lid margin laceration:
•Good alignment of the anatomy
•Closure of tarsal plate by absorbable suture vicryl 5-0 and closure to lid
margin by silk 5-0 and closure of the skin by simple interrupted suture.
•Laceration with tissue loss:
•1ry closure may later need graft or cantholysis.