Injury to the eye

Question 1

3 different types of trauma to the eye?

Answer 1

Blunt

chemical

lacerating

Question 2

What is this?

Causes?

what to look for in examination? (4)

Answer 2

RETRO BULBAR HEMMORHAGE,,,,,,,OPTHALMIC EMERGENCY

After any direct trauma to the orbit including surgery

Effectively a compartment syndrome of the eye socket with risk of complete loss of vision within hours

Ex

1. Tight swollen eyelid
2. Unilateral fixed dilated pupil
3. Reduced eye movements
4. Profound loss of vision

Tx

Need urgent canthotomy & cantholysis

cut the orbital septum on the lateral inferior aspect to stop compartment

Question 3

Orbital blow out fracture

Question 4

What type of chemical injuries r the worst and why?

Answer 4

ALKALI BURNS

Alkali burns most serious as continue to denature surface proteins and bc theyre LIPOPHILLIC they continue to penetrate eyeball for many hours

Need abundant irrigation for prolonged period until pH returns to normal

Question 5

What r the different types of chemical injuries?

Answer 5

Alkali , acidic, or neutral

Question 6

History taking in chemical injury to the eye?

Answer 6

The severity of ocular injury depends on four factors:

1. the toxicity of the chemical
2. how long the chemical is in contact with the eye
3. the depth of penetration
4. the area of involvement.

when the injury occurred?

whether they rinsed their eyes afterwards and for how long?

the mechanism of injury (was the chemical under high pressure?)

the type of chemical that splashed in the eye, and whether or not they were wearing eye protection?

• If available, it is helpful to obtain the packaging of the chemical. There is often product information on this packaging including chemical composition. If this information is not immediately available, chemical information can be found by contacting the local poison control center at aapcc or 1 800-222-1222.*
• *However, irrigation when needed should not be delayed to obtain any of this history.**

Question 7

Mx of chemical injury to eye

Answer 7

Minor splashes>> Irrigation and Topical antibiotics

Severe burns – ophthalmic emergency!·

IRAN’S ACT

1. Abudant IRRIGATION for prolonged period until pH returns to normal (pH – 7.2).>> pH should be checked again 15mins later bc some alkali may b stuck in the upper lid
2. REFER to on call team whilst still irrigating
3. Topical ANTIBIOTICS – prevents infection
4. STEROID drops – reduces inflammation and further corneal breakdown
5. ASCORBIC acid – cofactors in collagen synthesis depleted following chemical injury
6. CYCLOPLEGIC agents – comfort
7. Artificial TEARS – comfort