Boris Malyugin, M.D., PhD.'s presentation about Malyugin Ring® pearls. The key learning points of the presentation include the step-wise approach in managing small pupils, the main drivers for the decision to use pupil expander device, and the Malyugin Ring® implantation and removal pearls.
Boris Malyugin, M.D., PhD.'s presentation about Malyugin Ring® pearls. The key learning points of the presentation include the step-wise approach in managing small pupils, the main drivers for the decision to use pupil expander device, and the Malyugin Ring® implantation and removal pearls.
My technique to handle posterior polar cataractsanjay gupta
to handel a posterior polar catarct is always a challanging work g for all phacoemulsigfication surgeon. this presentation illustrate how to deal with such difficult cases of posterior polar cataract .
The cornea can recover from minor injuries on its own. If it is scratched, healthy cells slide over quickly and patch the injury before it causes infection or affects vision. But if a scratch causes a deep injury to the cornea, it will take longer to heal.
My technique to handle posterior polar cataractsanjay gupta
to handel a posterior polar catarct is always a challanging work g for all phacoemulsigfication surgeon. this presentation illustrate how to deal with such difficult cases of posterior polar cataract .
The cornea can recover from minor injuries on its own. If it is scratched, healthy cells slide over quickly and patch the injury before it causes infection or affects vision. But if a scratch causes a deep injury to the cornea, it will take longer to heal.
Ocular injuries- Third year mbbs OphthalmologyDrVarun5179
Topic- Injuries of eye and other manifestations
Subject- Ophthalmology
Category- MBBS notes for Third year MBBS students.
Created by- Medicforyou
Website- http://medicforyou.blogspot.com
For any feedback or queries, mail me at killer5179@gmail.com
Nearsightedness (myopia) is a common vision condition in which near objects appear clear, but objects farther away look blurry. It occurs when the shape of the eye — or the shape of certain parts of the eye — causes light rays to bend (refract) inaccurately. Light rays that should be focused on nerve tissues at the back of the eye (retina) are focused in front of the retina.
Nearsightedness usually develops during childhood and adolescence, and it usually becomes more stable between the ages of 20 and 40. Myopia tends to run in families.
A basic eye exam can confirm nearsightedness. You can compensate for the blurry vision with eyeglasses, contact lenses or refractive surgery.
This is a topic of sensory organ and this is detailed topic and can be refered by all nursing students bsc, msc and gnm which give you overall idea and things related to cataractwhich include definition, anat and physio, risk factor, pathophysiology, clinical menifestation, diagnostic evaluation, and management
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Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
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New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
1. Ocular
Trauma
Presenter :- Dr. Aakanksha V. Bele
Moderator :- Dr. Sachin Daigavane Sir
Conductor :- Dr. Shubhangi Nagpure Ma’am
Jawaharlal Nehru Medical college, Sawangi (M)
2.
3. Epidemiology
• Ocular trauma is major cause of preventable
monocular blindness and visual impairment
in world.
• WHO has reported 55 million eye injuries
causing restriction of daily activities, of
which 1.6 million go blind every day.
• The prevalence of ocular trauma to be 2.4%
of population in an urban city in India.
11.4% of these are blind.
4. Terminologies
• Closed globe injury – No full thickness wound of
eyeball
• Open globe injury – Full thickness wound of
eyeball
• Contusion – injury is due to direct delivery by the
object or to the changes in shape of the globe
• Lamellar laceration – Partial thickness wound of
eyeball
• Rupture – Full thickness wound – blunt object
• Laceration – full thickness wound by sharp object
• Penetrating injury – Entrance wound & retained
foreign object
• Perforating injury – Entrance and exit wounds
11. Is it an Ophthalmic Emergency ???
Yes
(Fire cracker injury/
Chemical Injury)
No
Complete evaluation of eye & ocular adnexa
Triage the patient
Intervene
13. History
• Date and time of injury
• Time lapse between injury and presentation at
hospital
• Mechanism of injury
• Visual Changes – If sudden or gradual
• Pain
• Diplopia
• Photophobia
• Use of glasses or protective eyewear
• Mechanical trauma with foreign object
- Size and shape
- Distance from which it came
- Exact location of impact
14. • Cases of foreign bodies
- Composition of foreign body, contamination
• Injuries from animals
- Type of animal and nature of injury
• Chemical Injuries
- Nature of chemical
• Past ocular history
- pre- existing ocular diseases
- Visual acuity prior to incidence
• Intraocular or periocular appliances
- IOL
- Scleral buckle
- Glaucoma drainage implant
• Tetanus immunization
15. General examination
• Head posture
• Facial symmetry
• Orbital fracture – crepitus, infraorbital
hypestheisa
16. Visual acuity
• Best possible bed
side
• No light perception
is not an indication
for primary
enucleation /
evisceration of eye
17. Eyebrow, eyelids and
eyelashes
• Abrasions, Clean lacerated wound,
marginal and canthal tears
including canalicular tears- probing
• Ecchymosis, oedema
• Ptosis, Foreign body
• Enophthalmos/exophthalmos
18. Scleral laceration
• Anterior :
- Better prognosis
- Associated with serious complication –
iridociliary prolapse, vitreous
incarceration (if not managed – fibrous
proliferation with incarcerated vitreous
with tractional RD)
• Posterior:
- Posterior to ora serrata
- Associated with retinal damage
19. Conjunctiva
• Chemosis, sub-conjunctival
Haemorrhage
• Examine fornices for any
foreign body
• Conjunctival foreign body,
abrasions (fluorescein
staining), lacerations
• Double eversion of upper
eyelid – Desmarres
retractor
20. Cornea
• Laceration - full/ partial
thickness
• Corneal foreign body –
metallic burr/ vegetative
matter
• Chemical burns
• Ulceration
• Corneoscleral tear with or
without iris prolapse
• In case of full thickness –
Siedel’s test
21. Anterior chamber
• Depth
• Gonioscopy
• Cells, flare – iritis
• Hyphaema,
hypopyon
• Cortical matter or
dislocated lens in AC
• Vitreous
• Foreign body
Shallow
- Open globe
- Traumatic intumescent cataract
- Occult scleral dehiscence
- Anterior dislocation of lens
Deep
- Angle recession
- Posterior occult scleral dehiscence
- Hypopyon/ hyphema
- Traumatic fibrinous uveitis
- Foreign body
- Lens matter
22. Pupil
• Shape and position
- Asymmetrical – open wound/ iris prolapse
- Dilated - iris trauma/ sphincter damage
- Scattering of perceive light – vitreous
hemorrhage
- Anisocoria – damage to sympathetic fibers -
miosis
- RAPD – in case of blunt trauma – traumatic
optic neuropathy
23. Lens
• Position – subluxation/
dislocation of lens
• Stability
• Clarity – traumatic cataract
– rosette shaped cataract/
sectoral cataract / vossius
ring
• Capsular integrity
• Torn anterior capsule
• Lens matter – compact/
loose/ flocculent
24. Extra ocular
movements
• Not to be done in case of open
globe
• Most important indicator of
suspected orbital injury
27. Management – First Aid
• Thorough eyewash – foreign body, chemical
injuries
• Cleaning and dressing of the wounds
• Do not give pressure on eyeball in case of
globe rupture
• Apply a shield in case of open globe injuries
• Tetanus immunization (if not immunized)
• Systemic analgesics and antibiotics
28. Closed globe injuries –
sub-conjunctival hemorrhage
• Rule out any other ocular injuries
- Wait and watch
- Lubricating and antibiotic eyedrops
- Oral vitamin C
29. Intra ocular foreign
body
• Superficial – remove with cotton swab
• Deep – 26 no. needle
• Metallic foreign body – remove the rust
ring
• Approach cornea tangentially
• Patch eye for 6 hours
• Very deep foreign body- remove under
microscope
• Complications – corneal opacity
30. Anterior chamber
foreign body
• Entry wound in cornea is closed
• Clear corneal incision in made away from the
wound
• Use of surgical gonioscopy lens (Koeppe’s lens)
for visualization
• Grasp with forceps and remove
• Metallic foreign body – use of intraocular
magnet
• Intralenticular foreign body
- Managed by lens extraction by
phacoemulsification and forceps extraction of
foreign body
31. Posterior segment
foreign body
• Immediate removal
• Stabilize the wound
• Pars plana lens extraction
• Stabilize and repair retina
• Forceps/ magnet removal of
foreign body
• Scleral buckling
• Intravitreal injections
32. Traumatic mydriasis
• Due to iris sphincter tear
• Pilocarpine eye drop
• Surgical repair- siepser sliding knot
technique – single pass single suture
33. Hyphema
• B-scan – to rule out posterior segment
involvement
• Topical prednisolone
• Cycloplegics
• T. Tranexamic Acid 500mg BD x 3 days
• Anti glaucoma medications – topical and
systemic
• Wear eye shield
• Propped up position
• Surgical intervention :
- Indications – corneal blood staining/ total
hyphema with IOP >50mmHg for >5 days/
unresolved after 9 days of treatment
- AC wash with/ without trabeculectomy
- Small gauge bimanual vitrectomy
Complications :
- Corneal blood staining
- Peripheral anterior synechiae
- Ischemic optic neuropathy
- Optic atrophy
- Decreased vision
- Visual field defects
- Amblyopia in children
34. Traumatic Cataract
• B-scan : to rule out retinal
detachment, tear, IOFB
• For advanced cataracts –
Phacoemulsification
• In c/o capsular instability - use of
capsular hooks and Capsular tension
ring
• Pars plana vitrectomy and
lensectomy
• Posterior capsulotomy and anterior
vitrectomy to be done in children to
avoid PCO
35. Traumatic
Subluxation of lens
• Spectacles/ contact lens
• Miotics
• Mild – capsular hook/ CTR with
phacoemulsification and PCIOL
• Severe – ICCE with ACIOL
• Severe with vitreous prolapse – Pars plana
vitrectomy + lensectomy
• Lens in AC – anti inflammatory, anti
glaucoma, DO NOT DILATE, lens extraction
with ACIOL or SFIOL
• Lens in vitreous cavity – PPV with
phacofragmentation
36. Management – Open
Globe Injuries
• Globe rupture
• Laceration
• Examination :
- 360 degree subconjunctival hemorrhage
- Jelly roll chemosis
- Asymmetry AC depth
- Transillumination defect
- Violation of anterior capsule, focal cataract
37. Open Globe Injuries
• Primary objectives :-
- Restore structural integrity
- Achieve watertight closure
- Prevent infection
- Smooth optically effective refractive surface to be restored
- Achieve spherical cornea –minimal astigmatism/ better contact lens fitting
- Reduce scarring
• Secondary objective :-
- Removal of disrupted lens and vitreous
- Avoid uveal and vitreous incarceration
- Removal of intraocular foreign body
38. Surgical Management – Lid repair
• Non – marginal lid laceration
- Subcutaneous closure
• Marginal lid laceration
- Vertical mattress suture
• Canalicular laceration
- Laceration near medial canthus – do probing
and check if any part is exposed
- Monocanalicular stent – for external 2/3rd of
one canaliculus
- Donut stent – silicone bicanalicular stent with
a pigtail probe
- Crawford stent
40. Scleral Tear Repair
• Start dissecting sclera anteriorly away from scleral wound
• Identify plane of dissection
• Identify edges of laceration
• Close as posteriorly as possible
• As sclera is slow healing – use 8-0 non- absorbable suture (provides structural support)
41. Corneal laceration - Non- surgical management
• In case of self sealed corneal laceration or those which can be sealed with help of tissue adhesives
or small conjunctival laceration.
• Tissue adhesives – cyanoacrylate glue – bandage contact lens
42. Corneoscleral laceration
– Surgical repair
• Primarily stabilize the limbus by 9-0 nylon suture
• Repair sclera in anterior to posterior direction
• Corneal periphery closed with long, tight sutures
• Corneal center closed with shorter and widely
spaced minimally compressive tissue bites
• Small sutures are to be taken near to the visual
axis – reduces astigmatism
• In case of iris incarceration with formed AC –
reposit the iris inside and suture the wound
• Devitalized or depigmented iris tissue should be
removed
• Perpendicular to laceration
• Single interrupted sutures
43. Ruptured globe repair
• Severe blunt trauma
• Usually anterior, in the vicinity of Schlemm
canal with prolapse of lens, iris, ciliary body
and vitreous
• Posterior rupture – asymmetry of anterior
chamber
• B-scan ultrasonography
• Exploratory surgery
• 360 degree conjunctival peritomy
• Bipolar cautery for hemostasis
• Wound closure performed as described earlier
44. Complications and outcomes
• Poor prognosis signs :-
- Initial visual acuity at presentation
- Length and width of laceration
- Lacerations of recti
- Involvement of lens
- Vitreous hemorrhage
- Retinal detachment
• Endophthalmitis, sympathetic ophthalmia
• Irregular astigmatism
45. Traumatic Optic
Neuropathy
• Follows ocular or orbital or head trauma
• Sudden visual loss with any ocular pathology
• Types:
- Direct – due to blunt or sharp optic nerve damage
- Indirect – force is transmitted secondarily to nerve
without apparent direct disruption due to impact
upon eye, orbit or other cranial structures
• High dose corticosteroids – iv methylprednisolone 30
mg/kg f/b 15 mg/kg 6 hourly x 3 days (to be started
with within first 8 hours
• Optic nerve decompression – if there is progressive
deterioration of vision despite steroids
47. Orbital Fracture
• Orbital injury can be contusive / penetrating
• Evaluation :
- Periorbital edema, laceration, foreign body
- Ptosis
- Crepitus/ bony discontinuity – orbital fracture
- Enophthalmos – large orbital fracture
- Exophthalmos – edema, hemorrhage, bony fragments
- EOM – muscle entrapment
- Check sensations – infraorbital nerve distribution
- Nasal passages – epistaxis, CSF rhinorrhea
48. Roof
Fracture
• Rare
• Falling on sharp objects
• Most common in children
• C/F – hematoma of upper eyelid, periocular
ecchymosis
• Exclude CSF leak
• Management – small fracture – no treatment
- Sizeable bony defect with downward
displacement of fragments – reconstructive
surgery
50. Theories of Blow- out fracture
• Direct injury(Retropulsion):
- Sudden compression of globe with
orbital floor fracture (increased orbital
and ocular pressure)
• Indirect injury (Buckling):
- Blow to inferior rim causes a ripple
effect causing fracture
51. Management
– Blow out
fractures
• Axial and coronal CT scan
• Systemic oral antibiotics, nasal decongestants, ice
packs
• Indication for surgery
- Entrapment of IR or perimuscular tissue with
diplopia
- Significant enophthalmos upto 7-10 days or high rish
of enophthalmos
• Surgery :
- Medial wall – Floor/ transcaruncular incision
- Orbital floor – approached through
transconjunctival/ sunciliary incision
- Entrapped tissues are released
- Orbital implant – nylon sheets, polyethylene, Teflon,
bone
53. Chemical Injuries
• True ocular emergency, every second counts
• Immediate irrigation
• Check ph if possible
• Alkali – severe damage – rapid penetration
• Acid – less damage – hydrogen ion precipitates
proteins and prevents penetration
• After thorough irrigation- record visual acuity and IOP
• Lids and lashes – crystallized chemicals
• Upper and lower fornix – swipe with cotton swab
• Size of corneal epithelial defect, limbal ischemia in
clock hours
• AC reaction
54. Thermal injuries – Hyperthermal injuries
3 Types :
1. Flame burns
- Scorched eyelashes/ brows
- Burned skin of lids
- Corneo epitheliopathy
- Damage to ocular tissue
- Whole eye/ orbital contents can be
incinerated
55. Thermal injuries – Hyperthermal injuries
• 2. Contact burns
- Conjunctiva – hyperemia/ violent chemosis/ grayish white coagulated plague
- Cornea- superficial or deep burns
• 3. Scald – second degree burn to hot fluids
- Conjunctival swelling
- Chemosis
- In chronic cases- symblepharon
56. Management of hyperthermal injuries
Lid burns
• Clean with normal saline
• Aseptic precautions
• Blisters fully open
• Loose epidermis – cut away
• Remnants of burnt lashes – removed
• Sofratulle dressing
• Full thickness burns – grafts (full thickness
skin graft)
Eye
• Avoid local analgesics
• Topical cycloplegics
• Systemic NSAIDs
• Antibiotics
• Ocular lubrication
• Glass rod
• Conjunctival transposition flap
• Corneal leucomatous opacity – keratoplasty
• AMG / limbal cell transplant
• Topical steroids
57. Hypothermal injuries
1. Surgical
• C/F :
- Corneal opacities
- Lens associated widespread cellular and
hemorrhagic changes
- Retinal arteries and veins – indistinct
- Retina – pale
- Optic disc – white
- Within 2 seconds of restoration of circulation
fundus becomes normal
58. Hypothermal injuries
2. Accidental :
• Exposure at high altitudes in snow storm
• C/F :
- Conjunctival hyperemia
- Corneal erosion/ opacity
Complications :
- Severe bilateral corneal ulceration –
permanent opacity of cornea
62. • Typically resulting from peri or retrobulbar local
anesthetic block
• Irreversible blindness
• Diagnosis :
- Proptosis, eye lid edema and ecchymosis
- Hemorrhagic chemosis
- Ocular motility dysfunction
- Decreased visual acuity
- Elevated IOP
- Optic disc swelling
- RAPD
Retrobulbar Hemorrhage
63. RBH - Treatment
• Medical :- Mannitol/ Steroids/ Anti
glaucoma drops
• Surgical :-
- Lateral cantholysis/ canthotomy
- Evacuation of hemorrhage
- Paracentesis
- Bony orbital decompression
64. Enucleation/
Evisceration
• Primary – extremely severe injuries
when it is impossible to repair sclera &
there is not prospect of retention of
vision
• Secondary – following primary repair, if
eye is severely and irreversible
damaged
• To be performed with 10 days of
original injury to prevent sympathetic
ophthalmitis
65. Prevention of
Ocular trauma
• Use helmet while
driving
• Use of protective
eyewear at workplace
• Parent education to
avoid eye injuries with
household items in
children
• Knowledge about first
aid
66. Bibliography
• Yanoff’s Ophthalmology 5th edition
• Kanski’s Clinical Ophthalmology 9th
edition
• Post graduate ophthalmology by
Zia Chaudhary 1st edition, volume
2
• Parson’s Diseases of the Eye 22nd
edition
• isotonline.org/betts/
1. inj to cornea and limbus
2. inj to ant 5mm of sclera
3. full thickness defect whose ant aspect is atleast 5 mm post to limbus
external (superficial inj) - bulbar conjunctiva/ sclera/ cornea
2. ant seg. and lens apparatus
3. post seg- struc post to lens capsule - retina/ vitreous/ uvea/ optic nv
Dr. Shukla 2013
Approved by ocular trauma society of india
Chalcosis
Siderosis
Angle recession – tear between the circular and longitudinal fibres of ciliary body
Subluxation – when a few fibres of suspensory ligament are torn, lens is subluxated but still is in pupillary area
Dislocation – all fibres of suspensory ligament are torn, lens is no longer in pupillary area. Posterior- vitreous, ant – in AC
Vossius ring – ring of pigment deposition on anterior lens capsule surface, significant of blunt trauma
Berlins oedema – damage to outer retinal layer caused by shock waves thst traverse the eye from site of impact following blunt trauma, reduces vn to <6/60, prog good
Retinitis sclopetaria- unusual, high speed missile inj to orbit. Large areas of choroidal and retinal rupture and necrosis with extensive subretinal and retinal hemorrhage
Use iris scissors to cut from lateral canthus to the rim of the orbit (canthotomy)
Cut inferior and sometimes both crus of lateral canthal ligament (cantholysis)
