1 / 17

UPDATE ON OCULAR TRAUMA

UPDATE ON OCULAR TRAUMA. Dr Tasha Micheli ‘North Shore Eye Surgery’ St. Leonards, Sydney. Epidemiology. Bimodal age distribution: 15-34yrs;>70 M/F: 3-5x Lifetime prevalence 20%: 3x recurrence risk 55,000,000 eye injuries annually 19,000,000: u/l blind

jana
Download Presentation

UPDATE ON OCULAR TRAUMA

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. UPDATE ON OCULAR TRAUMA Dr Tasha Micheli ‘North Shore Eye Surgery’ St. Leonards, Sydney

  2. Epidemiology • Bimodal age distribution: 15-34yrs;>70 • M/F: 3-5x • Lifetime prevalence 20%: 3x recurrence risk • 55,000,000 eye injuries annually • 19,000,000: u/l blind • 1.6,000,000:b/l blind • MVA’s, workplace,sports,falls(elderly) • PUBLIC HEALTH ISSUE

  3. Open Globe Injuries • Globe rupture: a F/T eye wall wound due to a BLUNT object(perforating injury) • Globe laceration: a F/T eye wall wound due to a SHARP object(penetrating eye injury)

  4. History- Open Globe • 1st-EYE SHIELD;medically stable • Detailed medical records • Symptoms:LOV,pain,diplopia,photophobia • Time,place,nature of injury(fist,hammering,MVA,fall,sports); ?witnesses • Object/FB type,size,composition(Fe,glass,metal-?magnetic,wood etc),velocity;?removed • Eyewear/protection worn • PEH-VA,eye Sx/trauma,drops(e.g. glaucoma) • Med/Hx-drugs,allergies,tetanus,etoh,last oral intake(GA)

  5. Penetrating Eye Injury • VA-near vision card;CF/HM/LP(initial VA is prognostic) • Direct ophth-l/o red reflex?retinal trauma • S/L:peaked pupil,iris prolapse,corneal +/scleral lacerations • Pupils:RAPD(optic nerve or diffuse retinal injury);mydriasis;3NP • EOM-DON’T TEST • External-face+/- lid laceration/s • N.B. A lid laceration is a PEI til proven otherwise • Crepitus;step(orbital blow-out) • Eye-conj(chemosis,s/c hrg,fb,ulcer) -cornea(fluorescein-cobalt blue) -iris,lens optic nerve • ALWAYS assess the ‘uninvolved’ eye-unrecognised injuries • Ix: CT scan(fine axial and coronal views)- IOFB • Rx: NBM;SBR • IV Anti-emetics;IV Analgesics;IV Broad-spectrum AnB(Ceftazidime & Vancomycin) • NO OINTMENTS ;NO EYEPAD • PLASTIC EYE SHIELD • +/- Tetanus prophylaxis

  6. Perforating Eye Injury • Assessment: • VA • Lid laceration/s • Ocular motility- ruptured globe;orbital wall fracture • S/L:rupture(limbus);hyphaema;iris t/illumination defects;focal cataract;’jelly-roll’ chemosis • Direct ophth-l/o red reflex • Ix: CT- orbital wall fracture;’soft’ eye ?posterior scleral rupture • Rx: Urgent primary repair • Rarely-primary enucleation/evisceration • Overall visual prognosis- very guarded

  7. Intra-ocular Foreign Body • 4 main goals of Rx: • 1.Preservation of vision • 2.Prevention of infection • 3.Restoration of normal eye anatomy • 4.Prevention of long-term complications

  8. Closed Globe Injuries • Ocular Surface Injuries • Traumatic S/Conj.Hrg • 360 deg +/- abn pupil ? open globe • Rx: lubricating drops; stop aspirin if O.K.,NSAID’s • Conj. Laceration • F/B trauma(poked in eye) • ?scleral laceration(?PEI) • <1cm- o/c AnB 5-7 days; must F/U in a few days • >1cm-eye Sx referral re: PEI; suturing

  9. Corneal Abrasion • Pain++,photophobia,redness,epiphora • Fingernail,chemicals,FB’s(CL’s),trauma • Evaluation: • Cobalt blue light-fluorescein staining • Linear(esp.vertical)-FB!-Evert lid/s • Rx: • Prompt referral-esp. if CL’s or organic material • o/c AnB q.i.d. 3-5 days; MUST r/v next day & VA • +/- cycloplegia( g.homatropine) q.i.d • Analgesia prn • Discard CL’s & CL’s case; No CL’s • Do NOT need eyepad • Warn- Recurrent Corneal Erosion Syndrome

  10. Corneal Foreign Body • Grinding,drilling,welding,hammering(metal on metal),CL’s • Retained organic material,metallic FB,rust ring • Rx: Shallow FB • S/L removal only if Amethocaine-soaked cotton bud unsuccessful • o/c AnB +/- cycloplegia qid; analgesia prn • Prompt referral: • >3 days epithelial defect • Incomplete r/o FB; rust ring • Deep FB ? PEI • Never provide anaesthetic drops(minims) to patients-delays corneal healing

  11. Chemical Injuries • Ocular Emergency • Alkalis- lime(CaO,plaster,concrete),oven & drain cleaners, ammonia • Acids-toilet & pool cleaners, car battery fluid • Rx: Immediate copious irrigation-N/S or Hartmann’s solution 30’( or at least until ocular pH=7.5) • N.B. White eye=poor prognosis(ischaemia) • Corneal thinning+/- perforation=patch graft/PK • Poisons Information Centre: 131 126 • Contact chemical’s manufacturer if ? Acid ?Alkali

  12. Flash Burn • Electric arc welding, sunlamps • S/L: diffuse punctate corneal epithelial erosions • Rx: see corneal abrasion • Corneal & Scleral Laceration • P/T(lamellar) – screwdriver,pencil;F/T • Deep lamellar • Rx:eye shield +/- superglue; suturing

  13. Anterior Chamber Injuries • Traumatic mydriasis • Traumatic iritis:3-4 days post-trauma • Iris sphincter tear/iridodialysis • Hyphaema-A/C hrg+/- fluid level;’8-ball’; • 38% rebleed 3-5 days later • Rx: Admit:kids,high IOP,rebleed,unreliable F/U,blood dyscrasias,severe • Cycloplegia;top c/s;eye shield;bed rest(bathroom privileges)-45 deg.HoB;daily review;long-term F/U-WARN re:angle-recession glaucoma

  14. Other Closed Globe Injuries • Lens:subluxation,dislocation,cataract,iritis • Posterior segment:PVD,vitreous hrg,retinal tear +/-detachment,retinal oedema • Eyelid laceration-a potential eye injury • Assess:object-blunt or sharp,organic/non-organic,removed?,animal bite • All wounds-explore thoroughly ? Globe injury • Refer: F/T or lid margin;globe trauma;nasal to lid punctum( NLD) • Ix: CT Cerebral & Orbital ? IOFB • Rx: superficial laceration

  15. Orbital Trauma • Blow-out Fracture • Thinnest orbital bones(medial floor;ethmoidal bone of medial wall) • Orbital floor fracture-inf.rectus muscle entrapment; infraorbital anaesthesia • Fist,squash ball • Pain,diplopia(esp.vertical),crepitus(on nose-blowing),hypoaesthesia • Evaluation:lid oedema,enophthalmos,ptosis • Palpation-orbital “step”,crepitus • Ocular motility restriction • Infraorbital nerve anaesthesia • S/L • Ix: Cerebral & Orbital CT Scan(fine axial & coronal views) • Rx:Eye referral, ice pack 1-2 days,Cephalexin 500 mg t.d.s.,nasal decongestants 7-10 days,no nose blowing,surgery >7-14 days

  16. Delayed Complications of Ocular Injury • Sympathetic Ophthalmia • Rare,b/l granulomatous uveitis • The ‘exciting’(injured) eye becomes inflamed as does the ‘sympathising’(previously normal) eye. • 0.2-0.5% post-open globe injury • 3 months(10 days-decades) • V.I.P.-examine ‘uninjured’ eye • Endophthalmitis • Clinical diagnosis;4-7%;2-3x if IOFB • Increasing eye pain,decreasing VA,hypopyon,uveitis • A/C & I/Vitreal cultures ASAP • I/Vitreal AnB • Gm+ve(Staph.epidermidis;Strep.) • Gm-ve(Pseudomonas) & fungi-less common • Poor visual prognosis

  17. Preventing Eye Injuries • General: • Working with chemicals-read instructions carefully,use gloves,then wash hands thoroughly • Workplace: Safety eyewear • House & Garden:Point spray nozzles away from you;protective goggles(rotary lawnmower,pruning etc.). Mowing-keep children away. • Store poisons in locked cupboards • Workshop:Powertools,welding,hammering metal on metal • Sports e.g. squash • 90% are preventable

More Related