This document provides an introduction to ocular trauma, including common causes, populations affected, assessment of injuries, and management principles. It discusses various types of injuries like mechanical, chemical, thermal, radiation and injuries from organic and non-organic materials. Modes of injury include tools/machinery, assaults, sports activities and war injuries. Assessment involves history, examination, and investigations like x-ray and CT. Injuries can range from mild to severe, with moderate and severe cases threatening vision.

1. INTRODUCTION
TO OCULAR
TRAUMA
P R E S E N T E R : D R . I D D I N D YA B AW E
M O D U L ATO R : D R . A M PA I R E A N N E M U S I K A
M A K E R E R E U N I V E R S I T Y
D E P A R T M E N T O F O P H T H A L M O L O G Y
A U G U S T 2 0 2 1

2. OUTLINE
• Introduction to ocular injuries
• Modes of ocular trauma
• Relevant studies
• Assessment of the injured eye

3. WHAT IS OCULAR INJURY
• Damage or trauma inflicted to the eye by external means
• The concept includes both surface injuries and intraocular injuries. During trauma soft
tissues and bony structures around the eye maybe involved

4. WHY LEARN ABOUT OCULAR TRAUMA?
• Cause of blindness or partial visual loss in half million people worldwide.
• Results in significant time off work
• Interesting to manage and challenging
• The results can be very rewarding

5. BACKGROUND
• Remains a major source of blindness in developed and developing world
• Eye injuries occur in economically active people:
-Usually Male,
- Average age of 39 years,
• Place of injury:
-Home (30.2%),
-Workplace (19.6%),
-Sports and leisure facilities (15.8%).

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7. BACKGROUND
• Causes:
-Tools, or Machinery (Home/work) – Approx 25%,
-assault (20%).
-Sports related activities (12.5%),
-war related injuries
• Eye injuries come at a high cost to society and are largely avoidable – severe anxiety,
loss of career opportunities, impaired quality of life, time off work

8. INTRODUCTION
• Injuries have their effect depending upon their severity
• Mild injuries have no residual effect
• Moderate and severe injuries can have vision threatening effects like loss of vision and
collateral damage to the ocular and orbital structures.
• Sympathetic ophthalmitis of the normal eye can occur

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• The vulnerable population are those involved in sports, industrial, farmers and
construction workers
• Mild injuries require conservative management whereas the severe injuries require
vigorous treatment.

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15. MODES OF OCULAR TRAUMA
• Wooden stick
• Stone
• Bull’s horn
• Motor vehicle accidents including fall from height, fall at home
• Fist blos
• War injuries including blast injuries
• Sports injuries (cricket ball injury, cork injuries)

16. INTRAOCULAR FOREIGN BODY
• USA –One IOFB in 18-49% of penetrating injuries
• Singapore survey – Annual rate of penetrating injuries 3.7 cases per 100,000 and IOFB is
present in 15% of these cases
• Males greater than female
• Age group – 20-40 years
• History is important
• Trauma at work – medicolegal issue and compensation
• Imaging very important

17. INJURIES IN PEDIATRIC AGE GROUP
• Ocular trauma is one of the treatable causes of blindness in children
• Ocular trauma is more in male children than female
• Outdoor activities are the most common causes
• Infants have ocular injury by the finger nail trauma due to rough handling by the
parents and the caretakers

18. MODE OF INJURY IN CHILDREN
• Domestic environment trauma: This included cases of injury due to stationary items, household items
• Trauma sustained during outdoor activities: This included cases of injuries while playing with ball,
stone, pellets, bow and arrow, wooden top, sticks
• Fire cracker injuries
• Road traffic accidents
• Animal attacks
• Agriculture field and work place related injuries: Injuries sustained in agricultural fields and other
places not meant for recreation

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22. OCULAR INJURY IN THE GERIATRIC
AGE GROUP
• The old age population > 60yr is prone for the injuries due to:
1) frequent falls,
2) road traffic accidents,
Sex predilection: females > males,
The visual prognosis is poor in the old age compared to other population

23. TYPES OF INJURIES
• Mechanical
• Chemical
• Thermal
• Radiational
• Electrical

24. MECHANICAL INJURIES
• The definitions proposed by Birmingham Eye Trauma Terminology (BETT) and as such
adopted by ‘American Ocular Trauma Society’ (AOTS) for mechanical ocular injuries are
as follows:-
• 1) Closed Globe Injuries: - Do not have a full thickness wound but there is intraocular
damage. Includes contusion and lamellar laceration.
• 2) Open globe injuries:- A full thickness wound of the sclera or cornea or both.
It includes rupture and laceration of eyeball.

25. BETTS ANIMATION

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30. CHEMICAL INJURIES
• Injuries with chemical include: alkali injuries and acid injuries
• Complications include scarring of eye and permanent visual loss

31. CHEMICAL INJURY
• Key principles
• Irrigation is key and makes the biggest difference
• If minor epithelial damage then antibiotics and lubricants will suffice
• Very low threshold to refer in to local eye A & E Dept.
• Will then be graded and managed accordingly

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42. THERMAL BURNS
• The thermal burns occur from fire or hot fluids
• Bilateral involvement of the eye with delayed onset 2-3 weeks after the initial burn
occurs
• Conjuctiva and cornea are effected in severe cases.

43. ELECTRIC INJURIES
• Source of electricity live electricity wire or flash of lightening
• Passage of electric current to the eye will involve the following injuries:
• Symptoms and signs:
-Conjuctiva: congested
-Iris and ciliary body: inflamed
-Lens: ‘electric cataract’- posterior sub capsular cataract
-Retinal haemorrhages
-Optic neuritis.

44. RADIATION INJURIES
• 1) Ultraviolet radiations:
• Photophthalmia: - occurrence of multiple epithelial erosions due to effect of UV rays
(290-311 micro) and senile cataract.
• Causes: Exposure to short circuit
• Industrial welders and cinema operators
• Snow blindness: - due to reflected UV rays from the snow surface

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• 2) Infrared radiations: Solar retinopathy/eclipse retinopathy
• Causes: due to direct/indirect sun viewing.
• Welding arc exposure
• Lightening retinopathy
• Retinal photoxicity from ophthalmic instruments like operating microscope

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• 3) Ionising radiational injuries:
• They are caused following the radiation therapy for the tumors.
• Radiation keratoconjuctivitis
• Radiation dermatitis of the lid
• The severity of the keratoconjuctivitis depends on the amount of radiation used for
therapy

47. RADIATION CATARACT
• 1) Infrared cataract: - discoid posterior subcapsular cataract
-Seen in the workers of glass industries
-Also known as ‘glass blowers or glass workers cataract.
• 2)Irradiation cataract:- exposure to X rays, gamma rays and neutrons
-6 months to few years is the time between exposure and development of cataract.

48. INJURIES WITH NON-ORGANIC AND
ORGANIC MATERIALS
• Organic materials tends to produce proliferative reaction and formation of granulation
tissue
• Injury with leaves, fronds, thorns, wood and caterpillar hair are organic injuries.
• Injuries with glass, plastics, stone, gold, silver are non-organic materials causing injury.

49. ASSESSMENT OF THE INJURED EYE
• Detailed history and meticulous note-taking
• Detailed examination
• Special investigations: -XR, CT, U/S

50. ORBITAL FRACTURES

51. LE FORT

52. IMPORTANT INFORMATION IN THE
HISTORY
• How the injury was sustained
• History of high velocity injury
• Circumstances of the injury should be carefully recorded - medico-legal implications

53. EXAMINATION
• A good examination is vital
• Critical to test the visual acutity/RAPD
• A visual acuity of 6/6 or 20/20 does not exclude a penetrating eye injury
• Gross external examination
• Ocular movements
• Slit lamp exam
• Fundus exam is possible

54. INVESTIGATIONS
• X-ray: -orbital fractures/suspected IOFB
• CT: -orbital fractures/IOFB
• MRI: - occult scleral ruptures, large haemorrhagic CD’s, dense VH
• B-scan: - VH, PVD, RD, CD. IOFB

55. CLINICAL PRESENTATION
• Examples in practice and management principles

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58. PLANNING FOR REMOVAL
• Explain what you’re going to do and ask patient if ok to proceed
• Anaesthetise the eye with topical drops
• Forehead all the way forward
• Keep the light to a minimum
• Hold the eyelid open (top lid)
• Keep needle parallel to the eye
• Topical antibiotics for a few days afterwards

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60. ALWAYS BE ALERT
• Especially as examination may be deceptive

61. IMAGING IS VERY IMPORTANT IN
SUCH CASES
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63. ALWAYS BE THOROUGH

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72. REFERENCES
• 1. Kuhn F, Morris R, Witherspoon CD, Heimann K, Jeffers JB, Treister G.A standardized
classification of ocular trauma. Ophthalmology. 1996 Feb;103(2):240-3.
• 2. Kuhn F1 Morris R, Witherspoon CD, Heimann K, Jeffers JB, Treister G. A standardized
classification of ocular trauma. Graefes Arch Clin Exp Ophthalmol. 1996 Jun;234(6):399-403.
• 3. Pieramici DJ, Sternberg P Jr, Aaberg TM Sr, Bridges WZ Jr, Capone A Jr, Cardillo JA, de Juan
E Jr, Kuhn F, Meredith TA, Mieler WF, Olsen TW, Rubsamen P, Stout T. A system for classifying
mechanical injuries of the eye (globe). The Ocular Trauma Classification Group.Am J
Ophthalmol. 1997 Jun;123(6):820-31.
• 4. Kuhn F, Morris R, Witherspoon CD, Mester V.J Fr Ophtalmol. The Birmingham Eye Trauma
Terminology system (BETT). 2004 Feb;27(2):206-10.