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Traumatic Eye Emergencies

HKCEM College Tutorial. Traumatic Eye Emergencies. Author Dr. TW Wong revised by Dr. Lam Pui Kin, Rex Oct., 2013. Objectives. Understand how to manage Eye injuries due to foreign body Blunt eye trauma Chemical injury. Case 1. M 40 R Eye discomfort after ? FB to eye

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Traumatic Eye Emergencies

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  1. HKCEM College Tutorial Traumatic Eye Emergencies Author Dr. TW Wongrevised by Dr. Lam Pui Kin, Rex Oct., 2013

  2. Objectives Understand how to manage • Eye injuries due to foreign body • Blunt eye trauma • Chemical injury

  3. Case 1 • M 40 • R Eye discomfort after ? FB to eye • Drilling with an electric drill • Tearing ++

  4. What do you find?

  5. What is the likely dx? Metallic Foreign Body (FB) to the eye

  6. What is the most important point in examination ? Visual Acuity

  7. If a corneal FB (iron dust) is found... • What is the treatment?

  8. Metallic FB in cornea • Should be removed under topical LA • In hospitals without urgent eye support, removal of non-axial FB can be attempted • Axial/ full thickness FB should be removed by eye specialists • rust ring need to be removed to prevent siderosis • antibiotic eyedrop +/- mydriatic • ATT • eye pad is not necessary

  9. If no obvious FB is noted, where else should you look for an FB How? Upper fornix by everting eyelid

  10. FB upper fornix Remove FB with a moistened cotton tip

  11. Irrespective of whether a FB is found What further test is necessary?

  12. Stain for cornea abrasion What is the treatment for this?

  13. Corneal abrasion • LA eye drop (e.g. novesin) stat for pain control • antibiotic eye drop • oral analgesic prn • ATT • urgent referral for eye FU • no need for patching

  14. What about this patient? Subconjunctival FB-- a piece of wood Penetration of globe should be R/O

  15. Think about ruptured globe if … • High velocity projectiles • Shallow anterior chamber • Hyphema • Irregular pupil or the pointing sign • Prolapsed iris • Bullous subconjunctival hemorrhage • Lens dislocation or opacification • Siedel test • Vitroeus hemorrhage • Retinal detachment

  16. Seidel’s test

  17. How to manage FB associated globe rupture? • Avoid pressure over injured globe • Supine • Rigid eye shield • Leave FB undisturbed • IV antibiotics • Pain control +/- antiemetic • ATT • NPO • Urgent Ophthalmologist consult

  18. You only find subconjunctival hemorrhage What would you do next ?

  19. X-ray orbit for IO FB High velocity FB e.g. hammer & chisel injury

  20. Case 2 • M 25 • Injury R eye • Hit by the badminton cock by accident during a game • R eye pain with VA impaired

  21. Exam for acute VA loss • Cornea • Anterior chamber • Lens • Vitreous • Retina • Visual field • EOM

  22. Corneal laceration

  23. What about this eye ? What else do you need to check?

  24. Hyphema • <20% in this patient • total hyphema => visual loss • rest in an upright position advised • urgent eye consult needed • Watch out for associated injuries and complications

  25. Visual prognosis

  26. What if the patient complains of floaters and flashes only with no obvious external injuries? Consider retinal detachment until proven otherwise

  27. What bedside investigation may help in diagnosis?

  28. Bottom line: Blunt injury +  VA Urgent referral to eye is necessary even if exam is normal in ED

  29. Case 3 • F 35 • unknown chemical spilled into eye • severe pain at first • irrigation done with tap water in workplace • VA difficult to test due to blepharospasm

  30. What is the most important property about the chemical that we need to know ? pH

  31. Which is worse? Acid or alkali • Alkali can cause persistent injury • liquefactive necrosis How do you test for pH ?

  32. Testing for pH What is the normal pH for tear?

  33. What should be our ED Tx ?

  34. Irrigation till pH normalise LA eye drop Eye retractor NS via drip Remember to retract lids and swab fornicesfor particulate matter

  35. Urgent refer to eye for all cases • Alkali burn • impaired VA • Corneal stain +ve

  36. Summary We have covered: 1. Eye injuries due to FB 2. Blunt eye trauma 3. Chemical injury

  37. The end

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