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Ophthamology > 9. Ocular Trauma > Flashcards

9. Ocular Trauma Flashcards

(102 cards)

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1
Q

What must always be considered first in eye trauma?

A

A life-threatening intracranial injury — assess for signs of skull fracture, brain injury, or CSF leak.

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2
Q

What structures are involved in periocular injury?

A

Bony orbit (e.g., orbital fracture)

Soft tissues (e.g., eyelid laceration, hematoma)

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3
Q

Why is it important to assess the bony orbit in eye trauma?

A

Because orbital fractures can entrap muscles, damage the optic nerve, or allow communication with the sinus cavities.

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4
Q

What are examples of soft tissue periocular injuries?

A

Eyelid lacerations

Periorbital bruising or edema

Lid margin or canalicular damage

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5
Q

What are the two broad types of ocular injury?

A

Blunt trauma

Penetrating trauma

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6
Q

What are common effects of blunt ocular trauma?

A

Hyphaema

Lens dislocation

Retinal detachment

Globe rupture

Orbital blowout fracture

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7
Q

What risks are associated with penetrating ocular trauma?

A

Open globe injury

Endophthalmitis

Foreign body retention

Risk of vision loss

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8
Q

What imaging is useful in assessing eye trauma?

A

CT orbits and brain (to assess for fractures, foreign bodies, and intracranial injury)

Ultrasound (if globe rupture is ruled out)

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9
Q

What is the first-line imaging modality in eye trauma?

A

CT scan, especially of the orbits and brain

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10
Q

Why is CT used in suspected intracranial injury from eye trauma?

A

To detect pneumocephalus, intracranial haemorrhage, or other brain injuries.

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11
Q

Why is CT the best modality for orbital and sinus imaging?

A

CT provides excellent detail of bony structures, sinuses, and orbital contents, making it ideal for detecting fractures and sinus involvement.

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12
Q

What is the role of CT in suspected intraocular or orbital foreign bodies?

A

CT has high sensitivity for detecting radio-opaque foreign bodies, making it the investigation of choice.

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13
Q

When should CT be used without delay?

A

In all cases of penetrating eye injury to assess for foreign bodies and globe integrity.

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14
Q

When should CT angiography be considered in eye trauma?

A

If there is suspected vascular injury, such as carotid-cavernous fistula or orbital hemorrhage.

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15
Q

When might an X-ray be used in eye trauma?

A

If CT is unavailable, a plain orbital X-ray can help identify metallic foreign bodies.

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16
Q

What bedside sign might raise suspicion of an intraocular foreign body?

A

If the patient reports pain or discomfort when looking up and down, suggesting a retained foreign body moving with eye movement.

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17
Q

When should you suspect intracranial penetration in eye trauma?

A

Maintain a high index of suspicion in cases of trans-orbital injuries, especially with deep or high-velocity trauma.

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18
Q

What delayed complications can occur after trans-orbital intracranial penetration?

A

Cerebral abscess

Meningitis

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19
Q

Why is intracranial infection a concern after orbital trauma?

A

The orbit is close to the brain, and penetrating injuries can breach the cranial cavity, introducing pathogens.

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20
Q

What is the imaging modality of choice to assess for intracranial penetration?

A

CT scan of the brain and orbits, with angiography if vascular injury is suspected

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21
Q

How should suspected intracranial penetration be managed?

A

Urgent neurosurgical and ophthalmological referral

IV antibiotics to reduce risk of infection

Close monitoring for signs of CNS infection

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22
Q

Basic trauma assessment

A
  • Examine periocular tissues – skin, eyelids (esp. lid margins and puncta), orbital rim
  • Instill local anaesthetic and use a speculum / modified paperclip to open lids if swollen
  • Check visual acuity
    Proptosis or enophthalmos?
  • Examine eye movements
  • Examine sclera, cornea, anterior chamber, pupil
  • Check red reflex
  • Do fundoscopy if possible
  • If suspicious of corneal abrasion instill fluorescein
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23
Q

Who should repair lid lacerations that involve the lid margin?

A

An ophthalmologist or a surgeon familiar with eyelid anatomy.

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24
Q

Why is specialist repair important for lid margin lacerations?

A

To ensure proper alignment, preserve lid function, and avoid complications like notching or trichiasis.

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25
In how many layers should a lid margin laceration be repaired?
Three layers: Tarsal plate (structural support) Orbicularis oculi muscle (function) Skin (cosmetic closure)
26
What is the risk if the layers are not aligned properly during repair?
Poor cosmetic outcome Lid malposition Impaired blinking or eye protection
27
What should you do if a lid laceration involves the canaliculus?
Refer urgently for microscopic surgical repair.
28
Why is early referral important in canalicular injuries?
To preserve tear drainage and prevent chronic epiphora (watery eye).
29
How are canalicular lacerations surgically managed?
Microsurgical repair of the canaliculus Placement of a stent (e.g., monocanalicular or bicanalicular silastic stent) to maintain patency during healing
30
Who should perform canalicular repair?
An ophthalmologist experienced in lacrimal system surgery or an oculoplastic surgeon.
31
What is a common consequence of incorrect lid margin repair?
A misaligned lid margin, which can lead to poor cosmetic and functional outcomes.
32
What can happen if the tarsal plate is not repaired properly?
A ridge or step may form at the lid margin, causing corneal irritation and scarring.
33
Why is precise tarsal plate alignment essential in lid laceration repair?
To ensure a smooth eyelid contour, maintain normal lid function, and protect the cornea during blinking.
34
What symptom might a patient experience if the repair causes corneal irritation?
Foreign body sensation, redness, tearing, and possibly blurred vision from corneal surface damage.
35
What is a blowout fracture?
A fracture of the orbital floor or medial wall, often caused by blunt trauma, which can trap orbital contents like the inferior rectus muscle.
36
What clinical sign may suggest a blowout fracture with muscle entrapment?
The patient is unable to look up due to entrapment of the inferior rectus muscle
37
What sensory deficit is commonly associated with blowout fractures?
Loss of infraorbital sensation due to injury of the infraorbital nerve.
38
What imaging finding supports the diagnosis of a blowout fracture?
Opacification of the maxillary sinus on CT, often with herniation or entrapment of orbital contents.
39
What is the preferred imaging modality for diagnosing a blowout fracture?
CT scan of the orbits.
40
What is a carotid-cavernous fistula (CCF)?
An abnormal connection between the carotid artery and the cavernous sinus, often following penetrating orbital trauma.
41
What causes a carotid-cavernous fistula?
Carotid artery injury leading to arterial blood flow into the cavernous sinus.
42
What are classic ocular signs of CCF?
Conjunctival chemosis (swollen conjunctiva) Proptosis (bulging eye) Dilated and tortuous conjunctival and retinal vessels
43
What neurological signs may appear with a CCF?
Cranial nerve dysfunction, particularly involving CN III, IV, V1/V2, and VI (which run through the cavernous sinus).
44
What auscultatory finding may indicate a CCF?
A bruit heard over the orbit or temple.
45
How should a suspected CCF be managed?
Urgent referral to neurosurgery for imaging and potential endovascular intervention.
46
What is a subperiosteal haematoma?
A collection of blood between the orbital bone and periosteum, typically following blunt orbital trauma.
47
What clinical sign is commonly seen in subperiosteal haematoma
Downward proptosis (displacement of the eye downward due to mass effect).
48
What causes a subperiosteal haematoma?
Blunt trauma to the orbit, often causing bleeding beneath the periosteum.
49
How is a subperiosteal haematoma treated?
It can be drained with a needle by an ophthalmologist to relieve pressure and prevent optic nerve damage.
50
Why is urgent drainage sometimes necessary?
To prevent optic nerve compression and permanent vision loss.
51
What is the first step in managing a foreign body on the eye surface?
Instill local anaesthetic eye drops to reduce pain and blinking.
52
How should you attempt initial removal of a superficial foreign body?
Moisten a cotton bud with local anaesthetic drops and gently try to remove the foreign body.
53
What if the foreign body cannot be removed with a cotton bud?
Refer the patient for slit-lamp assisted removal, usually done with a fine needle or spud by an ophthalmologist.
54
Why is slit-lamp removal important?
It provides magnification and illumination for safe and precise removal, reducing risk of corneal damage.
55
What is a rust ring in the eye?
A rust ring is a deposit of iron oxide left behind when a metallic foreign body is embedded in the cornea.
56
How adherent are rust rings and when can they be removed?
Rust rings are very adherent initially but tend to soften over 2–3 days, making removal easier.
57
What should patients be educated about after a rust ring injury?
The importance of protective eyewear to prevent future injuries.
58
Who performs rust ring removal?
Usually an ophthalmologist using specialized instruments once the rust ring has softened.
59
What should always be done if a patient complains of foreign body sensation in the eye?
Instill fluorescein dye to check for corneal abrasion or foreign body.
60
How does a corneal abrasion appear with fluorescein under blue light?
It stains bright green under blue light.
61
How does fluorescein-stained abrasion appear under white light?
It stains orange under white light.
62
What are the key management steps after removing a corneal foreign body or treating an abrasion?
Use a cycloplegic eye drop to relieve ciliary spasm Apply chloramphenicol eye ointment to prevent infection Double pad the eye for the first 24 hours (eye must stay closed under the pad) Continue chloramphenicol ointment four times daily for 5 days
63
When should the patient be asked to return?
If symptoms do not improve within 48 hours.
64
What causes ARC eye?
Ultraviolet (UV) light exposure causing corneal epithelial damage (UV keratitis).
65
How does ARC eye present on fluorescein staining?
Shows extensive punctate epithelial staining, best seen under blue light or slit-lamp examination.
66
What layer besides the corneal epithelium may be stained in ARC eye?
The tear film can also be stained with fluorescein.
67
What are the main treatments for ARC eye?
Analgesia for pain relief Cycloplegic drops to reduce ciliary spasm Cold compresses or pads to soothe discomfort Rest in a dark place to minimize light sensitivity
68
What reassurance can be given to the patient?
Symptoms typically resolve within 48 hours with appropriate treatment.
69
What is the recommended eye protection to prevent ARC eye from welding?
Use a proper welding mask with UV protection.
70
Should patients be sent home with local anaesthetic eye drops for eye pain?
No. Local anaesthetic eye drops should never be prescribed for home use
71
Why are local anaesthetic eye drops contraindicated for home use?
They inhibit corneal healing and mask warning symptoms, risking worsening injury.
72
What should be used instead to manage eye pain?
Use analgesics, cycloplegic drops, and other supportive measures.
73
What are common causes of subconjunctival haemorrhage?
Minor trauma, coughing, or Valsalva manoeuvre (straining).
74
What key clinical signs should be normal to reassure the patient?
Normal visual acuity, pupil reaction, eye movements, and fundus examination.
75
How should a subconjunctival haemorrhage be managed if no other abnormalities are present?
Reassure the patient and discharge with no treatment needed.
76
How long does a subconjunctival haemorrhage typically take to clear?
It usually resolves over 3–6 weeks.
77
What is hyphema?
Blood in the anterior chamber of the eye, usually due to trauma.
78
What are the main complications of hyphema?
Re-bleed (secondary bleeding) Raised intraocular pressure (IOP) Corneal staining from prolonged blood contact
79
What is the urgency of referral for hyphema?
Refer within 24 hours to an ophthalmologist for monitoring and management.
80
Why is re-bleeding a concern in hyphema?
It can cause worse vision loss and increase the risk of raised IO
81
When does re-bleeding usually occur after a hyphema?
Usually within the first 5 days after the initial injury.
82
Why is re-bleeding after hyphema dangerous?
It can cause blindness due to raised intraocular pressure.
83
What permanent damage can re-bleeding cause to the eye?
It may lead to permanent corneal staining from prolonged blood contact.
84
What is iris dialysis?
A tear or detachment of the iris root from its attachment to the ciliary body, often caused by blunt trauma.
85
What is a traumatic cataract?
Cataract formation caused by ocular trauma, resulting in lens opacity.
86
What does “displaced traumatic cataract in the anterior chamber” mean?
The lens or lens fragments have been displaced into the anterior chamber due to trauma, which is usually pathological.
87
What is an intact traumatic cataract in the anterior chamber?
A rare scenario where the cataractous lens remains whole but has shifted anteriorly; often debated or disputed clinically.
88
What is the most useful clinical sign of corneal or scleral disruption?
Prolapse of brown uveal tissue through the wound.
89
Where do ruptures of the globe most commonly occur?
Around the edge of the cornea, where the sclera is thinnest.
90
What area must always be examined in suspected globe rupture?
Always look under the eyelids to check for hidden wounds or uveal prolapse.
91
What does uveal prolapse indicate?
A full-thickness penetration or rupture of the globe, requiring urgent ophthalmic referral.
92
What eyelid sign may suggest a penetrating ocular injury?
A suspicious lid laceration, especially if aligned with the globe or extending deep.
93
What pupil shape may indicate globe penetration?
An oval or peaked pupil, often pointing toward the site of the injury.
94
What corneal finding suggests trauma near a laceration site?
Corneal haze around the laceration, indicating edema or inflammation
95
What anterior chamber sign is seen in penetrating injuries?
A flat anterior chamber, due to aqueous humor leakage.
96
What does visible iris prolapse through a wound indicate?
Full-thickness globe penetration with uveal tissue extrusion — an emergency.
97
Management of penetrating trauma
- Analgesia - Anti-emetic if necessary - Place a shield ONLY over the eye to prevent pressure on the ocular contents - DO NOT instill ointment or drops as these will end up inside the eye where they may be toxic - Avoid using a pressure dressing in case it causes further uveal prolapse - CT scan of the brain and orbit to exclude other injuries or foreign body - Refer
98
What is the first step in managing a patient with suspected penetrating ocular trauma?
Provide analgesia for pain relief and an anti-emetic if necessary to reduce the risk of Valsalva-induced worsening.
99
What type of protection should be placed over the injured eye?
A rigid eye shield only, to protect the eye without applying pressure to the globe.
100
What must be avoided in managing a penetrating eye injury?
Do not instill eye drops or ointments, as they may enter the eye and be toxic Avoid pressure dressings, which may worsen uveal prolapse
101
What imaging should be done in suspected penetrating ocular trauma?
A CT scan of the brain and orbit to assess for additional injury or retained foreign body.
102
What is the next step after initial management of a penetrating ocular injury?
Urgent referral to ophthalmology for surgical assessment and repair.

Ophthamology (12 decks)

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