8.ocular trauma

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TRAUMA1. Eyelid

2. Orbital blow-out fractures• Floor• Medial wall

• Blunt• Laceration

3. Ocular blunt and penetrating trauma• Anterior segment• Posterior segment

5. Intraocular foreign bodies

6. Chemical injuries

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Basal skull fracture - bilateral ring haematomas (‘panda eyes’)

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Repairing Lid lacerationCarefully align to prevent notching

Close tarsal plate with fine absorbable suture

Place additional marginalsilk sutures

Close skin with multiple interrupted 6-0 black silk sutures

Align with 6-0 black silk suture

Lid margin should be apposed precisely

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Canalicular laceration

• Repair within 24 hours• Chronic treating (epiphora) if not recognized

Or properly repaired

• Locate and approximate ends of laceration• Bridge defect with silicone tubing• Leave in situ for about 3 months

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The orbital rim protects the eye from injury by large objects

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• Periocular ecchymosis and oedema• Infraorbital nerve anaesthesia

• Ophthalmoplegia - typically in up- and down- gaze (double diplopia)

• Enophthalmos - if severe

Signs of orbital floor blow-out fracture

Hyposthesia: infraorbital nerve injury

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Investigations of orbital floor blow-out fracture

• Right blow-out fracture with ‘tear-drop’ sign

Coronal CT scanX-ray

1. Caldwell’s ( anterior posterior) view

2. Waters view – floor #

3. Lateral view

4. Submental vertex view zygomatic #

MRI: limited value

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Surgical treatment of blow-out fracture

Surgical repair in 2 weeks • Coronal CT scan following repair of right blow-out fracture with synthetic material Defect repaired with synthetic material

Autogenus: bone cartilage or facia

a b

c d

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Medial wall blow-out fracture

Signs

• Release of entrapped tissue• Repair of bony defect

Periorbital subcutaneous emphysema Ophthalmoplegia - adduction and abduction if medial rectus muscle is entrapped

Treatment

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Protective eyewears

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Def: Hemorrhage in space b/n the conj. And sclera

Causes: Blunt trauma Rubbing the eye

Strenuous activity

Rx. Resolves in 5 – 10 days

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Blunt ocular trauma

Equatorial expansion 128% increment

AP shortening 40%

Coup injury Counter coup

Small object

Force transmission

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Anterior segment ocular blunt trauma

Sphincter tear

Cataract Angle recession

Hyphaema

Lens subluxation

Iridodialysis Vossius ring

Rupture of globe

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Macular hole Optic neuropathyRetial tears

Posterior segment complications of blunt trauma

Choroidal rupture Commotio retinae Vitreous hemmorhage

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Hyphema

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Penetrating Trauma

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Penetrating trauma

Flat anterior chamber

Vitreous haemorrhage

Damage to lens and iris

EndophthalmitisTractional retinal detachment

Uveal prolapse

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Lacerations

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Traumatic Endophthalmitis

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Intraocular foreign bodies

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Intraocular foreign bodies

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Intraocular foreign bodies

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Detection and localization of IOFB

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Immediate IOFB Removal Depends on the site

Management of IOFB

Tetanus prophylaxis

IV antibiotics

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Retained IOFB

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Chemical burn

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Alkaline burn

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Acid burn

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Grading of severity of chemical injuries

• Clear cornea

Grade I (excellent prognosis)

• Limbal ischaemia - nil

• Cornea hazy but visible iris details

Grade II (good prognosis)

• Limbal ischaemia < 1/3

• No iris details

Grade III (guarded prognosis)

• Limbal ischaemia - 1/3 to 1/2

• Opaque cornea

Grade IV (very poor prognosis)

• Limbal ischaemia > 1/2

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Treatment of Chemical Injuries

1. Copious irrigation ( 15-30 min ) - to restore normal pH

2. Topical steroids ( first 7-10 days ) - to reduce inflammation

3. Topical and systemic ascorbic acid - to enhance collagen production

4. Topical cycloplegic - to reduce pain

5. Topical and systemic tetracycline - to inhibit collagenase and neutrophil activity

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Ultraviolet light burns

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Solar eclipse burn

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Management of Ocular trauma at GOPD

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Management of Ocular trauma at GOPD

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THANK YOU!

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