ocular trauma

Question 1

what are the classifications of mechanical injuries of the eye (BETTS) ?

Answer 1

open globe or closed globe

open globe is further divided into either rupture or lacerations

lacerations can be caused by : penetrating, perforating trauma or intraocular foreign bodies

closed globe mechanical injuries are further divided into - contusions , lamellar lacerations, superficial bodies

Question 2

what iis the difference between penetrating and perforating injuries ?

Answer 2

penetrating - enter with no exit
perforating - entry and exit portal

Question 3

what ocular findings may be associated with penetrating injuries ?

Answer 3

tear drop pupil ( iris prolapse) , the tear drop points towards the corneal injury
corneal tear
scleral perforation

Question 4

what is the most appropriate management for penetrating trauma ?

Answer 4

prompt surgical repair
pre and post surgical antibiotics
analgesics and anti-emetics
tetanus prophylaxis

Question 5

in traumatic injuries of the eye what are the possible causes of diminution of vision ?

Answer 5

corneal ulcers
hyphema
lens dislocation
traumatic cataract
vitreous hge
retinal detachement

Question 6

what. investigations would be required in cases of ocular trauma ?

Answer 6

ocular ultrasound - to viisualize thee posterior segment
Orbital CT

Question 7

what is the goal of treatment in regards to hyphema ?

Answer 7

to prevent re bleeding
to prevent complications associated with high IOP

Question 8

what is the treatment protocol for hyphema ?

Answer 8

1-Bed rest in a semi sitting position
2-Daily monitoring of IOP
3-No aspirin or non-steroidal anti-inflammatory drugs 4-Topical steroids to control iritis
5-Topical beta blockers to control IOP
6-Oral aminocaproic acid, an anti-fibrinolytic 50-100 mg/kg/4 hrs. to prevent re-bleeding.
7-Immediate evacuation of the hyphemia if there is increase in IOP or early blood staining in the cornea.

Question 9

what are the complications associated with ocular blunt trauma ?

Answer 9

fracture floor of the orbit “blow out fracture”
traumatic cataract
Iridodialysis
Corneal abrasions
Lens dislocation
Retinal detachement

Question 10

what are the bony components of the orbital floor ?

Answer 10

maxillary
zygomatic
palatine

Question 11

what are the clinical signs and symptoms associated with blow-out fracture ?

Answer 11

reduced vision
soft-tissue swelling - raccoon eyes
surgical emphysema
enopthalmous or proptosis due to retrobulbar hge
diplopia
hypoasthesia below orbital rim

Question 12

what is thee cause of hypoesthesia below the orbital rim ?

Answer 12

damage to thee infraorbital nerve

Question 13

what is thee management of blow out fracture ?

Answer 13

ABC - multitrauma
examination - always document VA and RAPD
facial X-ray and CT
broad spectrum ab
tetanus if theres any open wounds
avoid blowing nose ( eye lid swelling on blowing nose )
refer to ophthalmology

Question 14

what is the clinical image of traumatic cataract ?

Answer 14

rosette shaped cataract

Question 15

what is iridodialysis ?

Answer 15

seperation of the attachement of the iris form the ciliary body , resulting in a d shaped pupil

Question 16

what is the mgmnt for iridodialysis ?

Answer 16

cover the defect with coloured contact lenses
close the defect , suture the iris to the limbus

Question 17

what steps are important when assessing FB in the eye ?

Answer 17

visual acuity must be tested first
always flip the eye lid
sit lamp exam must be done
corneal fluorsceine staining

Question 18

when is urgent referral to an ophthalmologist needed ?

Answer 18

only in penetrating lesions or in cases of suspected infections

Question 19

what are the signs observed in siderosis bulbi and what is the
treatment ?

Answer 19

in the event of toxic effect of iron :
in the cornea : krukenberg spindle
lens : siderotic catarcat
iris and CB : atrophic changes , mydriasis
heterochromia

treatment : removal off the FB

Question 20

what is the presentation of chalcosis bulbi ?

Answer 20

toxic side effects of copper
cornea - KF rings
lens - sunflower cataract ( true cataract )

Question 21

what is the technique of removal for FB in the eye ?

Answer 21

topical anesthetic first - oxybuprocaine
approach eye from the side to avoid initiating the blink reflex
remove thee FB with a cotton tip
prescribe ointment and quinolone 4 times a day along with padding of the eye
follow up thee next day

Question 22

most seriious chemical burn ?

Answer 22

alkali burns

Question 23

what is the presentation of severe exposure to chemical injuries ?

Answer 23

conjunctival and episcleral whitening ( coagulative necrosis )
corneal oedema and opacification
severe iritis
secondary glaucoma
Posterior segment destruction

Question 24

what is the management in chemical injuries ?

Answer 24

immediate copious irrigation of the eye with plain water or saline irrigation
in severe exposure :
debridement of necrotic tissue
gloss rod lysis of symblepharon
avoid topical steroids if thee corneal epithelium is not intact

Question 25

what kind of imaging is contraindicated in FB ?

Answer 25

ferrous metallic FB should never undergo MRI

Question 26

what are the protective mechanisms of the eye ?

Answer 26

corneal sensation
tear fluid
eyelids and eyelashes
bony orbit
cushioning by surrounding fat
neck withdrawal reflex
constriction of the pupil to strong light