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Caring for patients with eye injuries, neoplastic growth of the eye . Lecturer: Lilya Ostrovska

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: Lilya Ostrovska

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  1. Caring for patients with eye injuries, neoplastic growth of the eye.Lecturer: LilyaOstrovska

  2. Ocular Trauma

  3. Nature of Injury • Blunt • Lacerating • Chemical

  4. Blunt Trauma • Mild – moderate • “bruise” ocular tissues • Eye wall intact • Moderate – severe • Rupture eye wall • Very severe consequences

  5. Lacerating Trauma • “cut” eye wall • Outcome depends on extent and location

  6. Location of Injury • Anterior Segment • Posterior Segment • Adnexa • Orbital Structures

  7. Anterior Segment • Conjunctiva • Cornea • Iris • Lens

  8. Posterior Segment • Vitreous • Retina • Optic nerve

  9. Adnexa • Eyelids • Lacrimal Structures

  10. Orbital Structures • Extraocular muscles • Bony walls

  11. Disgusting Photographs • Front to back…

  12. Racoon Eye

  13. Lid Laceration

  14. Subconjunctival Hemorrhage

  15. Corneal Foreign Body

  16. Corneal Abrasion

  17. Curling Iron Burn

  18. Corneal Laceration

  19. Iris Sphincter Rupture

  20. Hyphema

  21. Traumatic Cataract

  22. Vitreous Hemorrhage

  23. Retinal Hemorrhage

  24. Optic Disc Hemorrhage

  25. Orbital Wall Fracture

  26. Common Minor Eye Injuries • Corneal abrasion • Corneal foreign body • Chemical splash • Traumatic iritis

  27. Diagnosis • History • Sharp vs blunt vs chemical injury • Exam • CHECK VISION • CHECK VISION • CHECK VISION

  28. Diagnosis cont. • Exam – Pry lids apart! • Cornea clear? • Pupil round? • Pupil black? • Blood clotted behind cornea?

  29. Diagnosis cont. • Exam • Red reflex? • Eyes move symmetrically?

  30. Fluorescein Test • Topical “eye dye” • COBALT light

  31. Corneal Abrasion

  32. Abrasion Treatment • Erythromycin ointment • +/- patch • 1-2 day follow-up with eye doc

  33. Corneal Foreign Body

  34. 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

  35. Chemical Splash

  36. Chemical Treatment • IRRIGATE • Check pH • Minor • E-mycin ointment • 1 day follow-up eye doc • Major • Same day eval by eye doc

  37. Traumatic Iritis • Moderate blunt injury • Photophobia • Lid bruising/edema • Subconj heme or injection • Pupil sluggish • Eval by eye doc

  38. Please Do Not Confuse • Subconjunctival hemorrhage • Hyphema

  39. OCULAR ONCOLOGY

  40. OSSN • Ocular surface squamous neoplasia • Encompasses conjunctival/corneal intraepithelial neoplasia (CIN) • Squamous conjunctival dysplasia • Carcinoma in situ • Invasive squamous cell carcinoma (SCC)

  41. Squamous cell carcinoma • Extensive • Ill defined edges • Vascularised • Corneal involvement

  42. Conjunctival melanoma • Primary aquired conjunctival melanosis (PAM) • Preexisting conjunctival naevus • De novo

  43. Primary acquired conjunctival melanosis PAM • Biopsy if: • Growth • Nodule formation • Vascularity

  44. De novo conjunctival melanoma

  45. Rx Conjunctival SCC / Melanoma • Excision / cryotherapy to cut conjunctival margin • Topical Mitomycin C • Episcleral plaque radiotherapy if recurrence

  46. Iris melanoma

  47. Congenital hypertrophy of the retinal pigment epithelium (CHRPE)

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