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Ocular Trauma
- 1. OCULAR TRAUMA 20th August2020 DR M SAQUIB Vice Principal MBBS,MS , FSCEH DELHI,FHVDESAI PUNE, EX REGISTRARA JNMCH,AMU CONSULTANT OPHTHALMOLOGIST HOD D/O OPHTHALMOLOGY G.S .MEDICAL COLLEGE Founder sec: MEDICS India , Mail-dms2k5@gmail.com , 9634123800
- 2. TRAUMA EYE LID TRAUMA Laceration PeriocularHaematoma ORBITAL FRACTURE Blow out orbital fractures GLOBE TRAUMA Blunt Trauma Penetrating Trauma Foreign Body Shaken baby Syndrome CHEMICAL INJURIES2
- 3. â–¸ The eyeis protected from direct injury by lids, eyelashes and the projecting margins of the orbit. Nevertheless, it can be injured in a variety of ways; by chemicals, heat, radiation and mechanical trauma 3
- 4. Some key featuresof ocular trauma : â–¸ It is number one ocular emergency. â–¸ Leading cause of blindness, irrespective of age, sex and geographical status. (40% of monocular blindness) â–¸ Male & young age group is greater in incidence rate. â–¸ Efficient referral expected from the professionals. â–¸ Every persons should know about the importance of quick response to an ocular injury. â–¸ Prophylactic measure is always better than management.4
- 5. Etiological Classification -1.Accidental.2.Selfinflicted. 3. Occupational ▸ Uniform classification based on primary evaluation; Mechanical trauma to the eye are of two types: ▸ 1. Open globe injuries – full thickness defect of eye coats. ▸ 2. Closed globe injuries – injuries without full thickness of eye coats. 5
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- 8. Assessment: ▸ History- -should be detailed as possible - time & nature of injury - missile,blunt,?FB remaining,chemical etc. ▸ Past ocular history - VA, lid function - Immunization history • Rule out life threatening injuries • Rule out globe threatening injuries • Examine both eyes • Documentation +/- photograph • Plan for repair 8
- 9. 9 Closed Globe InjuryOpen Globe Injury Globe ( Sclera or Cornea ) does not have full thickness wound. Full thickness wound of sclera or cornea or both. Intraocular Damage Rupture – Blunt trauma Contusion – Blunt trauma Laceration – Penetrating Perforating Intraocular foreign body Lamellar Laceration – Sharp /Blunt Trauma ,Partial thickness wound
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- 11. Closed Globe Injury–Lamellar Laceration 11
- 12. Blunt Trauma â–¸ SportsInjury â–¸ Road Traffic Accident 12
- 13. Mechanics of blunttrauma forces â–¸ Direct Impact â–¸ Compression wave force Contre-coup â–¸ Reflected compression wave force â–¸ Rebound compression wave force â–¸ Indirect force 13
- 14. Mechanism of damage â–¸Tearing â–¸ Damage to tissue cells â–¸ Vascular Damage â–¸ Trophic changes- Nerve supply damage â–¸ Delayed complication 14
- 15. Effects Of ContusionAnd Concussion Injury 15 Ocular Tissue Involved Clinical Manifestation Orbit Blow out fracture of Medial wall /Floor ,Orbital Haematoma ,Carotid cavernous Fistula Eyelids Haematoma ,Avulsion of lower lid Conjuctiva Subconjuctival Haemorhage Anterior Uvea Hyphema ,Iris sphincter tear , Iridodialysis ,Angle recession ,Cyclodialysis Lens Rosette cataract ,Subluxation of lens ,Rupture of Anterior or Posterior Capsule Sclera Rupture ,Limbus or behind insertion of rectus ,Lamellar laceration Vitreous Haemorhage Choroid /Retina Choroid Rupture ,Suprachoroidal haemorhage ,RETINA: Haemorhage,Oedema ,Dialysis ,Detachment ,Commotio Retina Optic nerve Optic Nerve Avulsion ,Haemorhage
- 16. Orbit Trauma ▸ Suddenincrease in Intraorbital pressure due to compaction ▸ Object greater than 5cm in diameter . ▸ Floor > Medial wall weak ▸ Clinical Features: ▸ Periocular Echymosis ,Edema , Emphysema ▸ Infraorbital Nerve anaesthesia ▸ Diplopia –Muscle entrapment ▸ Enophthalmos ▸ Ocular Damamge16
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- 18. Diagnosis ▸ X ray ▸CT Scan –Coronal –Tear drop in Floor fracture ▸ Management Conservative Surgery 18
- 19. Closed Globe Injury–Cornea ▸ Simple Corneal Abrasion ▸ Recurrent Corneal abrasion ▸ Lamellar corneal laceration ▸ Corneal oedema ▸ Blood staining of cornea 19
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- 21. Closed Globe Injury–Anterior chamber ▸ Traumatic Hyphema – Blood in AC . ▸ Injury to Iris or cilliary body veseles . ▸ Treatment : Conservative – IOP control Surgical treatment –Drainage ▸ Exudates in AC due to uveitis 21
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- 23. Anterior Uvea -IrisInjury ,Pupil ,Ciliary Body â–¸ Iris compression against pupil , â–¸ Meiosis â–¸ Vossius Ring â–¸ Traumatic Mydriasis 23
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- 25. Iridodialysis â–¸ Detachment ofIris from its root at the ciliary body . â–¸ D shaped Pupil â–¸ Black Biconvex area at periphery 25
- 26. Intraocular Pressure ▸ Elevation–Hyphema ,Inflammation ▸ Hypotony – Ciliary Body shock 26
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- 28. Lenticular: ▸ Cataract – ConcussionCataract Cortical ,Sutures Are Delineated , Late Rosette Shaped , Capsule Integrity Access By B Scan ▸ Subluxation /Dislocation ▸ Tear of suspensory Ligament or Zonules . ▸ Contusion ▸ To and fro wave pressure ▸ Iridodenesis28
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- 30. Eyelid trauma Periocular Haematoma: - Generally innocuous but it is very important to exclude â–¸ 1. Trauma to the globe or orbit â–¸ 2. Orbital roof fracture â–¸ 3. Basal skull fracture 30
- 31. Laceration : 1. Superficiallacerations 2. Lid margin lacerations 3. Lacerations with mild tissue loss 4. Lacerations with extensive tissue loss 5. Canalicular lacerations 31
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