Ocular Trauma

Question 1

what are the six golden rules of eye trauma?

Answer 1

1. history is key
2. always record visual acuity
3. don’t forget fluorescein
4. handle suspected globe rupture with care
5. XR orbits if suspicious of intra-ocular foreign body
6. immediate irrigation of chemical injuries (solution to pollution is dilution)

Question 2

diagnosis of blow out fracture

Answer 2

tear drop or blood level in sinus on imaging

white eye blow-out fracture in kids

Question 3

what is a subconjunctival haemorrhage?

Answer 3

small blood vessels within the conjunctiva rupture

Question 4

causes of subconjunctival haemorrhage?

Answer 4

can be spontaneous
traumatic (coughing)
indicator of hypertension or bleeding diathesis (check meds)

Question 5

presenation of subconjunctival haemorrhage

Answer 5

bright red blood in front of sclera
painless
no change in vision

Question 6

management of subconjunctival haemorrhage

Answer 6

resorbs 10-14 days

Question 7

what is a corneal abrasion?

Answer 7

removal of epithelium

Question 8

causes of corneal abrasion

Answer 8

contact lenses
foreign body
fingernails

Question 9

presentation of corneal abrasion

Answer 9

severe pain (exposure of nerve endings)
lacrimation
sensitivity to light
miserable
blepharospasm (unable to open their eye)

Question 10

diagnosis of corneal abrasion

Answer 10

orange fluorescein drops

abrasion shows green in blue slit light examination

Question 11

management of corneal abrasion

Answer 11

topical anaesthetics (oxybuprocaine or tetracaine)
chloramphenicol

Question 12

presentation of corneal laceration

Answer 12

pupil may be misshapen if cornea involved

Question 13

what is seidel test used for?

Answer 13

assess anterior chamber leakage

Question 14

risks in a foreign body under the upper eyelid?

Answer 14

sub-tarsal scarring

damage conjunctiva

Question 15

presentation of foreign body

Answer 15

gritty eye
lacrimation
photophobia

Question 16

management of foreign body

Answer 16

topical LA and examine

once removed give chloramphenicol or fusidic acid

Question 17

what to consider with foreign bodies?

Answer 17

Welder’s arc eye

chemicals!

Question 18

what is traumatic uveitis?

Answer 18

inflammation of the uvea layer

Question 19

presentation of traumatic uveitis

Answer 19

24-48 hours later with photophobia

Question 20

what is a commotio retinae?

Answer 20

bruised retina

if affecting macula/fovea can have lasting impact on sight

Question 21

causes of commotio retinae

Answer 21

blunt trauma

Question 22

presentation of commotio retinae

Answer 22

lid oedema

opaque milky appearance in back of eye

Question 23

what is a synechia?

Answer 23

iris adheres to either the cornea or lens

Question 24

what conditions is a synechia common in?

Answer 24

iritis
iridocyclitis (or glaucoma)

Question 25

what is sympathetic ophthalmia

Answer 25

penetrating injury to one eye causes exposure of intra-ocular antigens leading to AI reaction in both eyes

can lead to bilateral blindness

Question 26

two types of burns

Answer 26

1. alkaline

2. acid

Question 27

what does an alkaline burn do to the eye?

Answer 27

rapid penetration due to liquefactive necrosis
cicatrising change conjunctiva and cornea
penetration of intra-ocular structures
ischaemia around limbus
china white eye

Question 28

what does an acid burn do to the eye?

Answer 28

coagulates protein

coagulative necrosis

Question 29

why is it difficult for the cornea to heal?

Answer 29

avascular

Question 30

management of burns

Answer 30

history= chemical (toxbase), when, beware of lime/cement
check pH and irrigate (minimum of 2L of saline until pH normalises)
assess at slit lamp

Question 31

causes of mydriasis (dilated pupil)

Answer 31

CNIII palsy
Holmes-Adie syndrome
raised ICP
congenital
trauma
stimulants (cocaine)
anticholinergics

Question 32

causes of miosis (constricted)

Answer 32

Horner's syndrome
cluster headaches
Argyll-Robertson pupil (neurosyphilis)
opiates
nicotine
pilocarpine