Flashcards in 2.1: Ocular Trauma Deck (23)
Of all the acute ocular presentations that present to hospital, what are the presenting complaints?
45% Red Inflamed Eyes
10% Miscellaneous - Reduced eye vision, visual disturbances, contact lens problems
What are the causes of ocular injuries?
Work related - often minor
Accidents around the home
Describe 3 mechanisms of trauma?
Penetrating - Large or small objects
Burns - Chemical or physical
Describe assessment of eye injury?
Examination of the eye - lids, conjunctiva, cornea, anterior segment, pupils, funds
Use fluorescein drops
What are the first three golden rules?
1. History is key
2. Visual Acuity is important
3. Don't forget Fluorescein
Describe a blow out fracture?
This is when the floor or the medial wall of the orbit fractures due to trauma. Can result in double vision, sunken orbital globes or loss of facial sensation
Describe a subconjunctival haemorrhage?
This is a bleed into the whites of the eyes caused by burst blood vessels
Describe globe rupture?
The integrity of the outer membranes is disrupted by blunt or penetrating trauma
Can result in vision loss
Describe traumatic uveitis?
Inflammation of the uvea caused by trauma - normally blunt but can include other types of trauma. Common in young males (not wearing eye protection)
What is hyphaema?
This is blood in the anterior chamber
Caused by trauma
May partially or completely block vision
Can result in permanent vision loss
What is retinal detachment?
This is when the retina detaches from the underlying layer of support tissue
Can be localised or broad (localised can progress)
Can progress to complete retinal detachment
May cause vision loss and blindness
What is penetrating trauma?
This is when something penetrates into the body (Eg: Skull, the globe, abdomen) and causes injury
What is sympathetic ophthalmia?
This is when injury occurs to one eye
Causes auto-immune reaction and inflammation in BOTH eyes
May lead to bilateral blindness from a unilateral injury
Describe small particles penetrating trauma?
Small particles can penetrate to many parts of the eyes
(Eg: Conjunctiva, sub-tarsal, cornea)
Worrying signs following small particle penetration include:
- Localised cataract
- Gross inflammation
- Irregular pupil
- Shallow anterior chamber
Describe intra-ocular small particles?
These are caused by fast moving small particles (Eg: Pieces from hammering and chiseling)
These require an X-Ray to determine location
What is the golden rule relating to penetrating trauma?
5. Always X-Ray if suspicious of intra-ocular foreign body
Describe chemical burns?
Can be caused by acid or alkali
Alkali has deep penetration (can cause ischaemia)
Acid has very little penetration (red surface)
Management of chemical burns?
Complication of chemical burns?
Can lead to end stage scarring and blindness
What is the final golden rule relating to chemical burns?
Immediate irrigation of chemical injuries
Describe prevention of ocular injuries?
- Training (up to date)
- Clear eye protection
- Rules in sport and work
Name the six golden rules?
1. Always get a good history
2. Always record visual acuity
3. Don't forget fluorescein
4. Handle suspected globe rupture with care
5. X-Ray orbits if you suspect intra-ocular foreign bodies
6. Immediate irrigation of chemical injuries