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Ocular trauma simplified
This document discusses the classification and management of ocular trauma. It covers various types of injuries including burns, chemical injuries, extraocular foreign bodies, blunt trauma, penetrating injuries, and their signs, symptoms, and treatments. Specific injuries to structures like the cornea, iris, lens, vitreous, and retina are described. The risks of infection and sympathetic ophthalmia are also outlined. The document provides an overview of evaluating and managing different types of penetrating ocular injuries and retained intraocular foreign bodies.
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Ocular trauma simplified
- 1.
- 2. CLASSIFICATION BURNS & CHEMICALINJURIES EXTRAOCULAR FB OCULAR INJURIES CONCUSSION OR BLUNT TRAUMA (CLOSED GLOBE INJURY) PENETRATING / PERFORATING INJURIES(OPEN GLOBE INJURY)
- 3. HEAT BURNS CAUSES HOT WATER STEAM HOTASH EXPLODING POWDER MOLTEN METAL
- 4.
- 5. TREATMENT COLD COMPRESSES LOCAL ANTIBIOTICOINT QID METHYL CELLULOSE E/D QID GLASS ROD TO PREVENT SYMBLEPHERON
- 6.
- 7. ALKALI BURNS STRONG AMMONIA- NECROSISOF CORNEA LIME BURNS- ISCHEMIA- COAGULATIVE NECROSIS OF- CONJUNCTIVA CORNEA SCLERA SYMBLEPHERON & OPAQUE CORNEA
- 8. TREATMENT COPIOUS IRRIGATION SWEEP FORNICESWITH COTTON BUD WEAK ACID-BORIC ACID,MILK,VIT C LIME BURNS-10%NEUTRAL AMM. TARTARATE, SODIUM EDTA ANTIBIOTIC OINT STEROID OINT GLASS ROD APPLICATION
- 9. ACID BURNS HCI, H2SO4 CHEMOSIS CORNEALDAMAGE SYMBLEPHERON LOCALISE DAMAGE BY PPT. PROTEINS- LESS PENETRATING
- 10. TREATMENT WASH WITH WATER WEAKALKALI AS 3% NaHCO3 IF EXTENSIVE CORNEAL DESTRUCTION- TREAT BY KERATOPLASTY * SUP. LAMELLAR * PENETRATING
- 11. WARFARE GASES LACRIMATORY GASES MUSTARDGAS ARSENICAL GAS
- 12. LACRIMATORY GAS ETHYL IODOACETATE BROMO BENZYL CYNATE CHLORO ACETO PHENON SYMPTOM- IRRITATION,LACRIMATION, BLEPHEROSPASM SIGN-CHEMOSIS Rx-IRRIGATE WITH SALINE OR 2%NaCO3
- 13. MUSTARD GAS DICHLORO ETHYLSULPHIDE S/S BLEPHAROSPASM CHEMOSIS ORANGE SKIN CORNEA Rx- IRRIGATE WITH NaHCO3 EMOLIENT DROPS ANTIBIOTIC OINT DARK GLASSES
- 15. EXTRAOCULAR FB PARTICLES OFCOAL,DUST EMERY,STEEL GRAINS OF CORN HUSK OF SEEDS WING OF INSECTS
- 16. CONJUNCTIVAL FB PALPEBRAL CONJ-SULCUS SUBTARSALIS FORNICES BULBAR CONJ Rx REMOVAL WITH COTTON BUD HYPODERMIC NEEDLE SNIP CONJ
- 17. CORNEAL F.B IED SYMPTOM-PAIN, LACRIMATION,PHOTOPHOBIA SIGN-MIOSIS, C.ULCER,HYPOPYON DIAGNOSIS-FLUORESCEINSTAIN Rx-4% XYLOCAINE,REMOVE WITH COTTON BUD,NEEDLE,F.BODY SPUD PAD & BANDAGE PROPHYLAXIS-FIT GUARDS ON MACHINES , PROTECTIVE GOGGLES.
- 18.
- 19. CORNEA CORNEAL ABRASION DISTORTION OFCORNEAL REFLEX(PLACIDO’S DISC) FLUORESCEIN STAIN +ve RECURRENT TRAUMATIC KERATALGIA FINGER NAIL SCRATCHES FLUORESCEIN STAIN +ve ON AWAKENING,LID RUBBING Rx-E/D CIPLOX 2HRLY x 1 WK -DEBRIDEMENT+EYE PADx48 HR
- 20. RUPTURE OF DESCEMET’SMEMB STROMAL OEDEMA—DEEP OPACITY Rx-5% NaCI Sol BLOOD STAINING OF CORNEA HYPHAEMA—INCREASED IOP— ENDOTHELIAL DAMAGE—BLOOD STAINING OF CORNEA Rx- LOWER IOP - EVACUATE HYPHAEMA
- 21. SCLERA RUPTURE OF GLOBE SUDDEN& VIOLENT FORCE FALL ON PROTRUDING OBJECT SUPERONASAL TEAR OF THIN SCLERA (3-4mm POST TO LIMBUS) --Sub/Conj. DISLOCATION OF LENS Rx- CAREFUL EXAM , GA PREFFERED RETRACT LIDS,CUT CONJUNCTIVA,SEE FOR SCLERAL TEAR
- 22. SUTURE SCLERAL TEAR IFSub/Conj. DISLOCATION OF LENS- REMOVE VITREOUS BY VITRECTOMY SUTURE SCLERA AFTER CLEARING VITREOUS FROM WOUND EXAMINE RETINA
- 23. IRIS & CILIARYBODY TRAUMATIC MIOSIS TRAUMATIC MYDRIASIS • ANTEFLEXION OF IRIS • RETROFLEXION OF IRIS • T. ANIRIDIA • IRIDODIALYSIS
- 24. • C.BODY – TORNNEAR IT’S ANT. ATTACHMENT – LONGITUDIONAL TEAR IN C. BODY – SPLIT CIRCULAR FROM RADIAL FIBRES —ANGLE RECESSION—DEEP AC— INCREASED IOP • Rx-REST – IRIDODIALYSIS-USE ATROPINE – ANCHOR IRIS EDGE WITH SILK SUTURE TO SCLERAL INCISION.
- 25. LENS • VOSSIOUS RING •CONCUSSION CATARACT – TEAR IN CAPSULE- AQUEOUS INFLOW – ROSETTE CATARACT —TOTAL CATARACT IN HRS TO FEW MONTHS. – Rx-ECCE+ PCIOL
- 26. • SUBLUXATION OFLENS – DEEP AC,IRIDODONESIS,EDGE OF LENS VISIBLE • DISLOCATION – ANT-IN AC(GLOBULE OF OIL) -MIOSIS-SPASM OF SPHINCTER -IRIDOCYCLITIS,SEC. GLAUCOMA – POST.- IN VITREOUS CAVITY -BLACK PUPIL -HIGH HYPERMETROPIA
- 27. • Rx- – AC-WIREVECTIS EXTRACTION WITH VITRECTOMY – VITREOUS-VITRECTOMY & LENS REMOVAL BY FRAGMATOME -USE OF PFCL TO BRING LENS INTO AC
- 28. VITREOUS • VITREOUS DETACHMENT –ANT. – POST. • VIT. HAEM. – Rx- VITRECTOMY
- 29. CHOROID • RUPTURE OFCHOROID – CHOROIDAL TEAR WITH VISIBLE WHITE SCLERA – IF MACULAR INV.-SEVERE VISUAL LOSS • CHOROIDAL HAEM.
- 31. RETINA • COMMOTIO RETINAE(BERLIN’S OEDEMA) –RETINAL OEDEMA—MACULAR CYST—M. HOLE.CHERRY RED SPOT AT MACULA. • RETINAL TEARS / DIALYSIS— RD • TRAUMATIC PROLIFERATIVE CHORIORETINOPATHY
- 33. OPTIC NERVE • OPTICATROPHY – HAEM IN SHEATHS OF OPTIC NERVE – SHEARING FORCE OR STRETCH – NERVE CAUGHT IN FRACTURED BONE ENDS – SNAPPING OF VESSELS • AVULSION OF OPTIC NERVE
- 34. I O P •HYPOTONY • RAISED IOP – DUE TO ANGLE RECESSION – DUE TO GHOST CELL OBS OF TRABECULAR MESHWORK
- 35. PENETERATING INJURIES • IMM.TRAUMA EFFECTS • INTRODUCTION OF INFECTION • POST-TRAUMATIC IRIDOCYLITIS • SYMPATHETIC OPHTHALMITIS
- 36. INTRODUCTION OF INFECTION •PYOGENIC ORGANISM- – CORNEAL WOUND—ENTRY—RAPID NECROSIS OF CORNEA—RING ABSCESS – PSEUDOMONAS(ANAEROBIC GRAM –VE ROD)—CHEMOSIS OF CONJUNCTIVA(GREEN DISCHARGE) —RELEASE ENZYME—LIQUIFY CORNEA—HYPOPYON—ENDOPTH— PANOPTH – Rx-INTENSIVE WITH POLYMIXIN B & GENTA
- 37. • CLOSTRIDIA WELCHI –VIRULENT PANOPHTHALMITIS – BROWNISH DISCHARGE – GAS BUBBLE IN AC – Rx— PENICILLIN I/V
- 38. • CLOSTRIDIUM TETANI –CEPHALIC TETANUS – ROAD ACCIDENTS – AGRICULTURAL ACCIDENTS – Rx * IF IMMUNISED-Inj TT * IF NOT IMMUNISED-PROPHYLACTIC TREATMENT
- 39. IMMEDIATE TRAUMA EFFECTS • CONJUNCTIVA –TEAR IN CONJUNCTIVA – Rx-STITCH
- 40. • CORNEA – CORNEALTEAR-LINEAR -LACERATED – SMALL & CENTRAL-MAY HEAL – INFECTED-Rx AS C. ULCER – LARGE TEAR-IRIS PROLAPSE • Rx-ABSCISSON / REPOSITION OF IRIS+REPAIR C.TEAR • CORNEOSCLERAL TEAR – Rx-REPAIR AFTER VITRECTOMY
- 41. • WOUNDS OFLENS(TRAUMATIC CATARACT) – ROSETTE SHAPED CATARACT -F. BODY TRACK -FLOCCULI IN AC
- 42. PENETERATING INJURIES WITH RETAINEDIOFB • IOFB – MECHANICAL EFFECTS – INTRODUCTION OF INFECTION – CHEMICAL ACTION OF FB • MINUTE CHIPS OF IRON,STEEL & STONE • GLASS PARTICLES • LEAD PELLETS • COPPER PERCUSSION CAPS • WOOD SPICULES
- 43. MECHANICAL EFFECTS • CORNEAL/SCLERAL TEAR • IRIS HOLE • CATARACT • VIT. HAEM. • RD
- 44. INFECTION • FOLLOWS INTRODUCTIONOF STONE OR WOOD PIECES • FLYING METALS- STERILE AS GENERATE HEAT • Rx- REMOVAL OF FB - ANTIBIOTICS
- 45. REACTION OF OCULAR TISSUETO FB DEPENDS ON CHEMICAL NATURE OF THE FB – NON ORGANISED MATERIAL – ORGANISED MATERIAL
- 46. NON-ORGANISED MATERIAL • INERT- GLASS,PLASTIC,PORCELAIN, GOLD,Ag,Pt& TENTALLUM • LOCAL IRRITATION—FIBROSIS • SUPPURATION-Zn,NICKEL,Hg • LOCAL REACTION-Al • MINIMAL REACTION-Pb PELLETS • DEGENERATIVE CHANGES-Fe,Cu
- 47. IRON(SIDEROSIS) • Fe++ JOINSCELLULAR PROTEINS —KILLS CELLS—ATROPHY – LENS-DEPOSITS ON ANT CAP. -CATARACT – IRIS-STAINED GREENISH—RED BROWN – RETINA-PIGMENTARY DYSTROPHY -DROP IN VA—BLIND – INCREASED IOP
- 48. COPPER/BRASS(CHALCOSIS) • PURE Cu-SUPPURATIONw/a ALLOY-MILD Rxn—CHALCOSIS • Cu++ ELECTROLYTIC DISSO.— DEPOSITED ON MEMB. – CORNEA-GOLDEN BROWN KF RING – LENS-SUNFLOWER CATARACT – RETINA – GOLDEN PLAQUES AT POST. POLE, NO DEG. CHANGES,GOOD VA
- 49. ORGANISED MATERIALS • WOOD& VEG MATTER— PROLIFERATIVE Rxn—GIANT CELL • EYE LASHES—AC, PROL. OF ROOT HAIR—I/O CYSTS • CATERPILLAR HAIR—SEVERE IRIDOCYCLITIS— GRANULOMATOUS NODULES (OPHTHALMIA NODOSA)
- 50. DIAGNOSIS OF IOFB •DETAILED ANT. SEG.& FUNDUS EXAM • X-RAY • USG • CT • BURMAN LOCATOR & DETECTOR
- 51. MANAGEMENT OF IOFB •REMOVAL UNLESS – INERT & STERILE – LITTLE DAMAGE TO VISION – REMOVAL PROCESS IS DETRIMENTAL TO GOOD VA • ANT. SEGMENT-REMOVE THRU ANT.ROUTE • IN LENS- REMOVE LENS
- 52. • POST. SEGMENT –3 PORT PARS PLANA VITRECTOMY WITH IOFB FORCEPS, DIAMOND TIP FB FORCEPS, IO MAGNET – PROGNOSIS- NOT GOOD • POST TRAUMATIC IRIDOCYCLITIS – Rx-STEROIDS- LOCAL/ SYSTEMIC
- 53. SYMPATHETIC OPHTHALMITIS • INFLAMMATION OFSOUND EYE AFTER INCARCERATION OF IRIS, CB,LENS CAPSULE • CILIARY ZONE IS DANGEROUS • IF SUPPURATION NO S.O. • IP-4-8WKS(9DAYS TO 40 YRS) • CF-EXCITING EYE -SYMPATHETIC EYE
- 54. ETIOLOGY • INFECTIVE: VIRALINFECTION • HYPERSENSTIVITY TO UVEAL PIGMENT- Ag-Ab Rxn • VIRAL INFECTION MODIFY UVEAL PIGMENT TO BECOME ANTIGENIC
- 55. SYMPATHISING EYE • PLASTICIRIDOCYCLITIS • NEURO RETINITIS • CHOROIDITIS • PRODROMAL S/S – SENSITIVITY TO LIGHT – INDISTINCT NEAR OBJECTS – LACRIMATION,TENDERNESS – CILIARY CONGESTION,KP – VITREOUS OPACITIES – ODEMA OF OPTIC DISC
- 56. • FULLY DEVELOPEDS.O. – ALL S/S OF PLASTIC OR SEROUS IRIDOCYCLITIS – COURSE : MAY RUN FOR 2-3 YRS • M/E – -EARLY STAGE-NODULAR AGGREGATION OF LYMPHOCYTES & PLASMA CELLS IN UVEA – DALEN FUCH’S NODULES-PIG.EPI. OF IRIS & CB PROL.—NODULAR AGG. +LYMPHOCYTES & EPI. CELLS. LATER ON GIANT CELLS(NO CASEATION) D/D –TB
- 57. EXCITING EYE • IRIDOCYCLITIS(PLASTIC) –LACRIMATION – CILIARY TENDERNESS – CILIARY INJECTION – KP • QUIESCENT STAGE—SHRUNKEN GLOBE • ON S.O.IN SOUND EYE RETURN OF ABOVE S/S IN EXCITING EYE
- 58. TREATMENT • PROPHYLACTIC TREATMENT –ENUCLEATION OF INJURED EYE IF NO REGAIN OF USEFUL VISION LIKELY • EXPECTANT TREATMENT – M/E SURGERY.ENTANGLEMENT OF IRIS,CB,LENS CAP RELEIVED & REPAIR DONE – Rx OF AC. IRIDOCYCLITIS-STEROIDS & MYDRIATICS – IF EYE STILL IRRITABLE- ENUCLEATION(WITHIN 9 DAYS)
- 59. • Rx OFSO – IF JUST DEV.& EXCITING EYE HAS NO USEFUL VISION—IMMEDIATE ENUCLEATION OF EXCITING EYE – Rx OF SYMPATHISING EYE AS OF IRIDOCYCLITIS -ORAL STEROIDS-2mg /Kg Wt PREDNISOLONE -S/TENON DEPOT STEROIDS -TOPICAL STEROIDS x MANY MONTHS