eye trauma

2. Objectives
OTo know the common forms of eye injury
OHow to take a hx, to do physical
examination
OTo know the possible sites of injury and
to take a general idea of each one

3. Numbers
OOcular trauma is the cause of blindness
in about half a million people worldwide.
O50% of the total injuries occur in patients
less than 25 yrs of age and 9-34% of them
in pediatric group.
O-M>>F 4:1

4. Forms of injury
OForeign body injury
OBlunt trauma
OPenetrating trauma
OChemical trauma ( acidic or alkali )

5. Injury sites
OAnterior segment (Conjunctiva, Cornea,
Iris, Lens)
OPosterior segment (Vitreous, Retina ,
Optic nerve)
OAdnexa (Eyelids, Lacrimal Structures )
OOrbital structures (Extraocular muscles
bony walls )

7. Befor everything
For all eye injuries:
ODO NOT touch, rub or apply pressure to
the eye.
ODO NOT try to remove the object stuck in
the eye.
ODo not apply ointment or medication to
the eye.
OSee a doctor as soon as possible,
preferably an ophthalmologist

8. determine the object

9. Symptomes and signs
OThe patient ’ s symptoms will relate to the
degree and type of trauma suffered.
OPain, lacrimation and blurring of vision,
red eye are common features of trauma
Omild symptoms obscure a foreign body
injury

10. Examination
OThe examination will depend on the type of injury.
In all cases it is important that visual acuity is
recorded in the injured and uninjured eye for
medico – legal reasons
OWithout a slit lamp
OWith a slit lamp

11. Orbital injury
OEmphysema
Opatch of paraesthesia
OLimitation of eye movements
Oenophthalmos :the eye may become
recessed into the orbit

13. Lid injury
OHematoma (traumatic black eye)
Olaceration

14. Lid laceration Tx
OSuturing to retain lid contour
OIf one of the lacrimal canaliculi is
damaged an attempt can be made to
repair it, but if repair is unsuccessful,
usually the remaining tear duct is capable
of draining all the tears.
OIf both canaliculi are involved, an attempt
at repair

15. Conjunctival injury
OChemosis (edema of conjunctiva)
OLaceration
OSubconjunctival hemorrhage

16. Corneal injury
OAbrasion
OForeign body
ORupture
Orecurrent corneal erosion.

17. Abrasion
Most common eye injury
Oloss of the epithelial layer
OTypical causes: fingernails, mascara
brushes, debris, chemical injuries,
extended use of contact lenses, iatrogenic
OThe instillation of fluorescein will identify
the extent of an abrasion

19. Corneal abrasion Tx
OProphylactic antibiotic ointment, with or
without an eye pad.
ODilatation of the pupil with cyclopentolate
1% can help to relieve the pain caused by
spasm of the ciliary muscle

20. Foreign body

21. FB Tx
Oremoved with a needle under topical
anesthesia
OSub tarsal objects can often be swept
away with a cotton - wool bud from the
everted lid.
OThe patient is then treated as for an
abrasion.
O-If Injury penetrated the globe, eye should
be examined carefully with dilation of
pupil
Oto see the lens and retina

22. Anterior chamber
OHyphaema : accumulation of blood in
anterior chamber
Ocaused by rupture of the root of the iris
blood vessels, or iris dialysis (Torn away
from its insertion to ciliary body)
COMPLICATIONS
Ore-bleeding (5-6 days after injury),
Oincreased IOP
Ocornea staining with blood and traumatic
mydriasis

24. Tx
-Children needs hospital admission for few
days
-Adult treated at home
-REST !!!
-Steroids decrease risk of rebleeding , BB
,pupil dilation. ( No aspirin or NSAID)
-usually responds to medical treatment, but
occasionally surgical intervention is
required

25. Rupture globe
(Scleral rupture)
Ooccurs when the integrity of the outer membranes
of the eye is disrupted by blunt or penetrating
trauma
Oophthalmologic emergency
Ooccur when a blunt object impacts the orbit,
compressing the globe along the anterior-posterior
axis causing an elevation in intraocular pressure to
a point that the sclera tears

26. Rupture globe
(Scleral rupture)
It is critical to avoid putting pressure on a ruptured globe
to prevent any potential extrusion of intraocular
contents and to avoid further damage
ODecrease in visual acuity, pain ,watering, redness.
ODecrease in anterior chamber depth.
ODecrease in IOP
OIn penetrating injuries the shape of the pupil may be
distorted if the peripheral iris has plugged a penetrating
corneal wound (uveal prolapse)26

28. Treatment
OPrehospital
OA suspected or obvious ruptured globe
should be protected from any pressure or
inadvertent contact with a rigid shield
during transport.
OImpaled foreign bodies should be left
undisturbed.
OEye patches are contraindicated

29. Treatment
OER
OPlace Fox eye shield or other rigid device
OAdminister antiemetics (eg, ondansetron)
to prevent Valsalva maneuvers
OAdminister sedation and analgesics as
needed

30. OAvoid any topical eye solutions (eg,
fluorescein, tetracaine, cycloplegics) in
cases of known globe perforation or
rupture
OAdminister prophylactic antibiotics
OEnsure the patient is kept nothing by
mouth (NPO)

31. Pupil
OTraumatic miosis (due to iridocyclitis, It
occurs initially due to irritation of ciliary
nerves
OTraumatic mydriasis (due to 3rd nerve
palsy) + -blurring of vision (loss of
accommodation).

32. Iris
OTraumatic iritis: inflammation of iris and
ciliary body after any type of trauma due
to exposure of antigens.
OTraumatic sphincter tears defects in
constrictor pupillae muscle at the pupillary
border , V- shaped tears (avoid
mydriatics)
OIridodialysis separation of the root of iris
from its insertion on the ciliary body,
produce a D-shaped pupil
Otraumatic aniridia

34. Ciliary body
OTraumatic spasm or paralysis of
accommodation ... temporary myopia
OHypotony ; suppression of secretion of
aqueous humour
OAngle recession glaucoma (2ry glaucoma)
onset is often delayed

35. Lens
OSubluxation of the lens . It may occur due to partial
tear of zonules. The subluxated Lens is slightly
displaced but still present in the pupillary area
O
Odislocation >>fluttering of the iris diaphragm on
eye movement (iridiodonesis)
OTraumatic cataract after blunt or penetrating injury
(Posterior sub-capsular), within hours and
transient
OStar or stellate shape appears
Vossius’ Ring

37. Vitreous
OHemorrhage If there is no red reflex and
no fundus details are visible, this
suggests a vitreous hemorrhage
OFloaters
OFloaters and spots typically appear when
tiny pieces of the vitrous break loose
within the inner back portion of the eye.
OProlapse

39. Vitreous hemorrhage
Vitreous Hemorrhage Treatment:
Omay absorb over several weeks, or may
require removal by vitrectomy

40. Optic nerve
OTraumatic optic neuropathy caused by
avulsion of the blood vessels supplying
the optic nerve.
OAlthough this is uncommon, it leads to
a profound loss of vision and no
treatment is available.
Ooptic nerve atrophy is often seen 3-6
weeks after the injury.

42. Choroid
O-Rupture: linear rupture, white lines, edges may be
covered with hemorrhage. (Asymptomatic or
decrease in Visual Acuity)
O-Traumatic choroiditis
O-Effusion or hemorrhage may occur under the
Oretina (subretinal) or may even enter the vitreous
Oif retina is also torn.
O-Spontaneous choroidal detachment:
Odue to hypotony

43. Retina
OCommotio retinae damage to the outer retinal
layers caused by shock waves that traverse the
eye from the site of impact following blunt trauma
OUnder examination the ritina appears opaqe and
white in colour most commonly seen in the
posterior pole and may seen in the periphery but
the blood vessles are normally seen
Ocharacterized by decreased vision in the injured
eye a few hours after the injury

44. Symptoms
1. spontaneous recovery in 3-4 weeks
2. visual recovery is limited if associated with
macular involvement
3. degeneration, macular holes, choroidal
rupture
Signs
1. whitish-grayish opacification
2. scattered retinal hemorrhages
3. cherry red fovea

45. Retina
Commotio retinaeTreatment of
OIt usually spontaneously resolves, but
requires careful observation since retinal
holes may develop in affected areas and
may lead to subsequent retinal
detachment.

46. ORetinal tears or retinal dialysis
ORetinal detachment
ORetinal hemorrhage
46

47. Retina
Treatment of Retinal dialysis:
Osurgical intervention to repair any
detached retina

48. Retinal Hemorrhage

49. Penetrating Trauma
Clinical effects
1. Mechanical:
Owounds on cornea, conjunctiva and-sclera
OUveal prolapse
Otraumatic cataract
2. Infection: severe in 24-48 hrs., fungal delayed
3. Sympathetic ophthalmia:
diffuse bilateral uveitis of both eyes after trauma to one eye,
may
develop in days and up to several years… Blindness
Symptoms may develop from days to several years after a
penetrating eye injury 49

50. Examination:
Oeyes should be gently examined
OAvoid direct pressure on globe .

51. IOFB
OMetallic vs non metallic
ORetained, iron - containing foreign bodies may
have an insidious and particularly devastating
effect on the eye (siderosis oculi).Due to
generation of free radicals
lead to
Oa progressive, pigmentary degeneration of the
retina.
OA discoloration of the iris (heterochromia) ,
Oa fixed mydriasis ,
Ocataract can be a late clues to the diagnosis.

52. OFailure to detect and remove such a foreign
body at the time of injury results in irreversible
blindness
OCopper containing foreign bodies causes
keyser feischer rings and endophthalmitis

53. Chemical injury
OAlkali more severe than acids because they
penetrate more.
OThe conjunctiva may appear white and ischemic.
If such changes are extensive, involving the
greater part of the limbal circumference, corneal
healing will be grossly impaired because of
damage to the epithelial stem cells of the cornea,
which are located at the limbus
53

54. Chemical injury
OA prolonged epithelial defect may lead to
a corneal ‘melt’ (keratolysis)
OThere will be additional complications
such as uveitis, secondary glaucoma and
cataract.

55. Chemical injury
Treatment :
OThe most important part of the treatment is to irrigate
the eye immediately with COPIOUS quantities of clean
water at the time of the accident.
Oirrigate under the upper and lower lid to remove solid
particles
Onature of the chemical can then be ascertained by
history and measuring tear pH with litmus paper
OSteroids, pupil dilators.
OVitamin C orally and topically to improve healing and
delay ulceration

56. Chemical injury
OAnticollagenases (e.g.: tetracycline) orally and topically to
reduce risk of corneal melting by inhibiting matrix
metalloproteinases.
Olimbal stem cell transplantation
Oin case of extensive damage of limbus preventing re-
epithelialization of cornea and as a result melting of it
(keratolysis) with time. Cells are taken either from the
normal, fellow eye or from a donor source
Ooverlay of amniotic membrane which protects and
maintains the underlying tissue and promotes resurfacing.

59. This beautiful eye reflects the
beauty of it’s creater