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11/15 Ocular Trauma
Neuro
26
Medical
Graduate
11/18/2011

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Term
ocular trauma
Definition
most common cause of unilateral blindness (90% preventable!)

routine and serious types of injuries
Term
routine injuries
Definition
corneal abrasion

conjunctival and corneal foreign body
Term
potentially serious injuries
Definition
chemical burn

blunt injury to the eye

lacerating injury to the eye

intraocular foreign body

orbital wall fractures
Term
assessing ocular trauma
Definition
*HISTORY* is critical
-mechanism: foreign body, chemical injury
-timing
-uni vs. bilateral

past ocular history
-baseline vision
-previous surgeries (increases risk for having injury deeper in eye, even with minor trauma)
Term
pain in ocular trauma
Definition
pain is NOT always proportional to the severity of the injury

sensory innervation:
CN V (trigeminal)
-anterior globe, extensive
-posterior globe, none (retina, choroid, sclera)
-referred pain from damaged extraocular structures
Term
ocular trauma evaluation
Definition
basic eye exam:

visual acuity ASAP
pen light
pupils, motility

minimize palpation or forcing lids open when suspicious of open globe injury
Term
chemical burn
Definition
IRRIGATION IMMEDIATELY

alkalis penetrate and cause more permanent damage

remove particulate matter from conjunctival sac and cornea

topical antibiotic

refer immediately
Term
foreign body
Definition
superficial and conjunctival foreign bodies are the most common cause of ocular injuries but RARELY cause severe or permanent ocular damage
Term
foreign body removal

conjunctival
Definition
may have to evert lids

use topical anesthetic and irrigate to flush out FB, or use cotton tipped applicator
Term
post-foreign body removal
Definition
stain the corneal surface to identify defects

trat with topical antibiotic

refer within 24 hours if corneal defect, and with symptoms when FB can't be identified
Term
corneal foreign body
Definition
usually more symptomatic

MUST use topical anesthetic, then irrigate

refer if rust ring - need to get it ALL out

if injury is deeper than corneal epithelium, scarring will occur, which may result in permanent loss of vision
Term
corneal abrasions
Definition
very common

may not be seen without slit-lamp and fluorescein staining

often from contact lens abuse
-topical anesthetic dramatically relieves pain
**do NOT give/prescribe topical anesthetic drops to patient**
Term
corneal abrasion management and FU
Definition
pressure patch to prevent eye from opening

refer if persistent defect, pain, corneal edema after 2 days

if contact lens wearer - refer and no patch, antibiotic drops; high risk of infection
Term
blunt injury
Definition
extent of injury is difficult to assess from initial external eval

get history, apply eye SHEILD

refer immediately
Term
black eye "plus"
Definition
blunt injury involving fracture of orbital bones

may get extra ocular muscle entrapment limited globe movement
Term
subconjunctival hemorrhage
Definition
selt limiting

seolves in about 2 weeks

need a complete eye exam to rule out any other associated ocular injury
Term
irregular pupil
Definition
a peaking pupil in the setting of trauma = BAD

indicated rupture of the iris sphincter muscle

possible severe ocular injury

shield eye and refer right away
Term
hyphema
Definition
layering of RBC

bleeding into the anterior chamber

shield and refer ASAP

indicated severe ocular trauma
Term
lens dislocation or retinal injury
Definition
shield and refer ASAP
Term
lid lacerations
Definition
openings in the top and bottom of the lids drain to lacrimal sac and duct - can get permanent tearing if not repaired correctly

can get laceration parallel to lid margin (not at bad) or within the lid margin-->must be repaired by an ophthamologist
Term
lid and globe lacerations
Definition
lid lacerations can be associated with globe lacerations - manage accordingly

very serious

shield and refer for eval ASAP
Term
triage of globe lacerations
Definition
be suspicious from history

usually associated with a "foreign" object - knife, tool, nail, staple, windshield glass, small objects at high speed - or severe blunt injury
Term
globe laceration management
Definition
removal must be done in a controlled setting

check vision in each eye

look for hemorrhage, hyphema, abnormal pupil reactions/irregular pupil, prolapse of iris/ciliary body

Triage - Shield - Refer ASAP
Term
potential outcomes of globe lacerations
Definition
sever injury can cause loss of useful vision, marked disruption of intraocular structures, enucleation of non-salvageable tissue

later: corneal scars, glaucoma, cataract
Term
prevention of ocular trauma
Definition
protective eye wear, including goggles, spectacles
-sports
-occupations

national standards: polycarbonate 3mm central thickness, industrial frame, 100% UV blockage
Term
ocular trauma

managament cliff notes
Definition
chemical burns: irrigate immediately

foreign bodies: refer to ophthalmologist with corneal abrasion, central location

corneal abrasion: do not patch in contact lens patients

blunt trauma/laceration: refer after triage
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