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Caring for patients with eye injuries, neoplastic growth of the eye . Lecturer: Lilya Ostrovska. Ocular Trauma. Nature of Injury. Blunt Lacerating Chemical. Blunt Trauma. Mild – moderate “bruise” ocular tissues Eye wall intact Moderate – severe Rupture eye wall
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Caring for patients with eye injuries, neoplastic growth of the eye.Lecturer: LilyaOstrovska
Nature of Injury • Blunt • Lacerating • Chemical
Blunt Trauma • Mild – moderate • “bruise” ocular tissues • Eye wall intact • Moderate – severe • Rupture eye wall • Very severe consequences
Lacerating Trauma • “cut” eye wall • Outcome depends on extent and location
Location of Injury • Anterior Segment • Posterior Segment • Adnexa • Orbital Structures
Anterior Segment • Conjunctiva • Cornea • Iris • Lens
Posterior Segment • Vitreous • Retina • Optic nerve
Adnexa • Eyelids • Lacrimal Structures
Orbital Structures • Extraocular muscles • Bony walls
Disgusting Photographs • Front to back…
Common Minor Eye Injuries • Corneal abrasion • Corneal foreign body • Chemical splash • Traumatic iritis
Diagnosis • History • Sharp vs blunt vs chemical injury • Exam • CHECK VISION • CHECK VISION • CHECK VISION
Diagnosis cont. • Exam – Pry lids apart! • Cornea clear? • Pupil round? • Pupil black? • Blood clotted behind cornea?
Diagnosis cont. • Exam • Red reflex? • Eyes move symmetrically?
Fluorescein Test • Topical “eye dye” • COBALT light
Abrasion Treatment • Erythromycin ointment • +/- patch • 1-2 day follow-up with eye doc
Foreign Body Treatment • Anesthetize eye • Remove FB • Cotton swab (don’t worsen abrasion!) • Kimura spatula • +/- needle tip • E-mycin and +/- patch • 1-2 day follow-up with eye doc
Chemical Treatment • IRRIGATE • Check pH • Minor • E-mycin ointment • 1 day follow-up eye doc • Major • Same day eval by eye doc
Traumatic Iritis • Moderate blunt injury • Photophobia • Lid bruising/edema • Subconj heme or injection • Pupil sluggish • Eval by eye doc
Please Do Not Confuse • Subconjunctival hemorrhage • Hyphema
OSSN • Ocular surface squamous neoplasia • Encompasses conjunctival/corneal intraepithelial neoplasia (CIN) • Squamous conjunctival dysplasia • Carcinoma in situ • Invasive squamous cell carcinoma (SCC)
Squamous cell carcinoma • Extensive • Ill defined edges • Vascularised • Corneal involvement
Conjunctival melanoma • Primary aquired conjunctival melanosis (PAM) • Preexisting conjunctival naevus • De novo
Primary acquired conjunctival melanosis PAM • Biopsy if: • Growth • Nodule formation • Vascularity
Rx Conjunctival SCC / Melanoma • Excision / cryotherapy to cut conjunctival margin • Topical Mitomycin C • Episcleral plaque radiotherapy if recurrence
Congenital hypertrophy of the retinal pigment epithelium (CHRPE)