Open globe close globe injury with treatment explained in detail

3.  1.CLOSED INJURY
 2.OPEN INJURY
 3.CONTUSION
 4.RUPTURE
 5.LACERATION
 6.LAMELLAR LACERATION
 7.INCISED INJURY
 8.PENETRATING INJURY
 9.PERFORATION

4.  PLAIN RADIOGRAPH
 ULTRASONOGRAPHY
 CT SCAN
 MRI
 ELECTRODIAGNOSTIC TESTS

5.  AP COMPRESSION WITH EQUATORIAL
EXPANSION WITH TRANSIENT BUT SEVERE
INCREASE IN IOP
 PRIMARY BLOW IS USUALLY ABSORBED BY
LENS IRIS DIAPHRAGM AND VITREOUS BASE

7.  CORNEAL ABRASION WITH BREACH IN
EPITHELIUM AND MIGHT STAIN POSITIVE WITH
FLUORESCEIN.
 ACUTE CORNEAL EDEMA – FOCAL/DIFFUSE
DYSFUNCTION OF ENDOTHELIUM .FOLDS IN
DESCEMETS MEMBRANE AND STROMAL
THICKENING.
 CLEARS SPONTANEOUSLY
 VERTICAL TEAR IN DESCEMET MEMBRANE –
USUALLY BIRTH TRAUMA

9.  SOURCE OF BLEED – IRIS ROOT AND CILIARY
BODY FACE
 UNCONTROLLED HIGH IOP CAN LEAD TO
ISCHAEMIC OPTIC NEUROPATHY AND THUS
STAINING OF CORNEA

10.  1.PUPIL-
 VOSSIUS RING –CONSTRICTED PUPIL
IMPRESSES UPON LENS THUS PIGMENT FROM
PUPILLARY MARGIN FORM VOSSIUS RING.
 TRAUMATIC MYDRIASIS- DUE TO IRIS
SPHINCTER DAMAGE. RL IS SLUGGISH
 RADIAL TEARS ARE COMMON

12.  2. IRIDODIALYSIS-
 IRIS DEHISCENCE FROM CB AT IT’S ROOT
 PUPIL IS D SHAPED AND DIALYSIS IS
BICONVEX IN SHAPE NEAR LIMBUS
 TRAUMATIC ANIRIDIA ( 360 DEGREE
IRIDODIALYSIS ) IS RARE.

13.  HYPHAEMA AND INFLAMMATION LEAD TO
RAISED IOP
 TEARS EXTENDING INTO THE FACE OF CB (
ANGLE RECESSION ) IS ASSOCIATED WTH 6 TO
9 PERCENT RISK OF LATE GLAUCOMA

14.  CATARACT- ROSSETTE CATARACT
DUE TO DIRECT DAMAGE TO THE LENS FIBRES
AND RUPTURE IN LENS CAPSULE WITH AQ
HUMOR INFLUX, HYDRATION OF LENS FIBRE
AND CONSEQUENT OPACIFICATION.
POSTERIOR SUBCAPSULAR CORTEX ALONG THE
POSTERIOR SUTURES,

16.  2.SUBLUXATION-SUBLUXATION OF LENS DUE
TO TEARING OF SUSPENSORY LIGAMENT, THUS
DEVIATE TOWARDS MERIDIAN OF INTACT
ZONULES. AC DEEPENS.. IRIDODONESIS AND
PHAKODODENESIS.
1.LENTICULAR ASTIGMATISM

17.  3.DISLOCATION- DUE TO 360 DEGREE
RUPTURE OF ZONULAR FIBRES .LENS MAY
DISLOCATE INTO VITREOUS

18.  Worst prognosis when just perception of light
is there.
 Anterior rupture at the vicinity of schlemm’s
canal with prolapse of lens, iris, CB and
vitreous.
 Deep ac with rotation of iris lens diaphragm.
Low iop
 Mostly behind the insertion of rectus where
sclera is the thinnest

20.  POSTERIOR VITREOUS DETACHMENT.
 PIGMENT CELL ( TOBACCO DUST) CAN BE
SEEN FLOATING IN ANTERIOR VITREOUS

21.  CONCUSSION OF SENSORY RETINA WHICH
RESULTS IN CLOUDY RETINA WHICH GIVES IT A
GREY COLORED APPEARANCE.
 TEMPORAL FUNDUS IS INVOLVED.
 CHERRY RED SPOTS AT MACULA
 SEVERE INVOLVEMENT –INTRARETINAL
HEMORRHAGE WHICH CAN INVOLVE THE MACULA.
 MILD – SPONTANEOUS RESOLUTION IN 6 WEEKS.
 SEVERE- COMMOTIO PROGRESSIVE PIGMENTARY
DEGENERATION AND MACULAR HOLE FORMATION.

23.  CHOROID, BRUCH MEMBRANE AND RPE.
 DIRECT- ANTERIORLY AND ALONG THE ORA
SERRATA
 INDIRECT- OPPOSITE THE SITE OF IMPACT,
FRESH RUPTURE IS OBSCURED BY SUBRETINAL
HEMORRHAGE, WHICH MAY BREAK THRU THE
ILM WITH RESULTANT SUBHYALOID OR VH.
 POOR VPE IF FOVEA IS INVOLVED.
 LATER UNCOMMON COMPLICATION IS
FORMATION OF CHOROIDAL NEOVASCULAR
MEMBRANE IN THE REGION OF RUPTURE

25.  TRAUMA LEADS TO 10 PERCENT OF RD
 1.RETINAL DIALYSIS-BREAK OCCURRING AT THE
ORA SERRATA CAUSED BY TRACTION FROM
RELATIVELY INELASTIC VITREOUS GEL ALONG THE
POSTERIOR ASPECT OF VITREOUS BASE. TEAR MAY
LEAD TO AVULSION OF VITREOUS BASE – BUCKET
HANDLE APPEARANCE COMPRISING A STRIP OF
CILIARY EPITHELIUM,ORA SERRATA AND IMMEDIATE
POST –ORA RETINA INTO WHICH BASAL VITROUS
GEL REMAINS INSERTED.
 TRAUMATIC DIALYSIS OCCURS IN THE
SUPERONASAL AND INFEROTEMPORAL
QUADRANTS.

27.  DUE TO DIRECT RETINAL DISRUPTION AT THE
POINT OF SCLERAL IMPACT.

28.  SECONDARY TO A GIANT TEAR MAY
OCCASIONALLY BE SEEN.

29.  MAY OCCUR AT THE EITHER AT THE TIME OF
INJURY OR FOLLOWING RESOLUTION OF
COMMOTIO RETINAE.

30.  IT FOLLOWS OCULAR,ORBITAL OR HEAD
TRAUMA.
 IT OCCURS IN 5 PERCENT OF FACIAL
FRACTURES.

31.  1.DIRECT-DUE TO BLUNT OR SHARP OPTIC
NERVE DAMAGE FROM AGENTS SUCH AS
DISPLACED BONY FRAGMENTS, A PROJECTILE
OR LOCAL HEMATOMA.
 2.INDIRECT-FORCE IS TRANSMITTED
SECONDARILY TO THE NERVE WITHOUT
APPARENT DIRECT DISRUPTION DUE TO
IMPACTS UPON THE EYE,ORBIT OR OTHER
CRANIAL STRUCTURES.

33.  CONTUSION,DEFORMATION,COMPRESSION,OR
TRANSECTION OF NERVE, INTRANEURAL
HAEMORRHAGE,SHEARING, SECONDARY
VASOSPASM, OEDEMA AND TRANSMISSION OF A
SHOCK WAVE THROUGH THE ORBIT.

34.  INDIRECT NEUROPATHY IS MORE COMMON
THEN DIRECT NEUROPATHY.
 POOR VISION IN 50 PERCENT OF THE CASES
WITH JUST PL+
 AFFERENT PUPILLARY DEFECT M/C.
 INITIALLY OPTIC NERVE HEAD AND FUNDUS
ARE NORMAL WITH PALLOR DEVELOPING OVER
SUBSEQUENT DAYS AND WEEKS.
 EXCLUDE COMPRESSIVE ORBITAL
HAEMORRHAGE.

35.  CT
 MRI

36.  SPONTANEOUS VISUAL IMPROVEMENT SEEN IN
UPTO HALF OF PATIENTS WITH AN INDIRECT
INJURY.
 1.STEROIDS- I.V. METHYLPREDNISOLONE IN
HEALTHY PT WITH SEVRE VISUAL LOSS OR IN
THOSE WITH DELAYED VISUAL LOSS. SHOULD BE
STARTED WITHIN 8HRS N THEIR USE IS STILL
CONTROVERSIAL.
 2.OPTIC NERVE DECOMPRESSION ( ENDONASAL,
TRANSETHMOIDAL) IF PROGRESSIVE VISUAL
DETERIORATION DESPITE STEROIDS,
COMPRESSION OF OPTIC NERVE BY BONY
FRAGMENTS OR HAEMATOMA MAY ALSO BE AN
INDICATION.

37.  WHEN AN OBJECT INTRUDES BETWEEN GLOBE
AND ORBITAL WALL DISPLACING THE EYE.
SUDDEN EXTREME ROTATION OR ANTERIOR
DISPLACEMENT OF GLOBE
 AVULSION MAY BE ISOLATED OR OCCURS IN
ASSOCIATION WITH OTHER OCULAR OR
ORBITAL INJURIES.
 FUNDUS- STRIKING CAVITY WHERE OPTIC
NERVE HEAD HAS RETRACTED FROM ITS
DURAL SHEATH. NO TREATMENT AVAILABLE.

38. ACUTE SHOWING
PERIPAPILLARY HEMORRHAGES
TEMPORAL CUPPING

39.  UNDER AGE 2YRS
 PHYSICAL ABUSE ( SHAKEN BABY SYNDROME).
BY VIOLENT SHAKING OF BABY.
 MORTALITY IS 25 PERCENT
 PATTERN OF INJURY IS BY ROTATIONAL
ACCELERATION AND DECELERATION OF HEAD ,
IN CONTRAST TO LINEAR FORCES GENERATED
BY FALL.BRAIN STEM TRACTION INJURY
CAUSES APNEA AND CONSEQUENT HYPOXIA
LEADS TO RAISED ICP AND ISCHEMIA.

40.  IRRITABLE, LETHARGIC AND HISTORY OF
VOMITING.

41.  IMPACT HEAD INJURY- SKULL FRACTURES TO
SOFT TISSUE BRUISES.
 SDH AND SAH IS COMMON.
 MULTIPLE RIBS AND LONG BONE FRACTURES
MAY BE SEEN.

42.  1.RETINAL HEMORRHAGES- B/L OR U/L ARE
MOST COMMON.
 MULTIPLE LAYERS ARE INVOLVED WHICH MAY
BE PRE OR SUBRETINAL
 M/C- POSTERIOR POLE BUT OFTEN EXTEND
TO PERIPHERY.
 PERIOCULAR BRUISING AND SUBCONJUCTIVAL
HEMORRHAGES.
 POOR VISUAL RESPONSES AND AFFERENT
PUPILLARY DEFECT.
 VISUAL LOSS OCCURS IN 20 PERCENT OF
CASES