Ocular Trauma

Question 1

What are the possible mechanisms for ocular trauma?

Answer 1

Foreign body
Chemical injury
Blunt trauma
Penetrating trauma

Question 2

What is the presenting complaint of foreign body injury?

Answer 2

Sudden onset irritation and photophobia

Question 3

What is the PC of a chemical injury?

Answer 3

Corneal clouding

Question 4

What is the treatment of chemical injury?

Answer 4

Irrigation with saline (several litres)

What substance is involved - pH checks

antibiotics
vitamin C
steroids
mydriatics

Question 5

what complications can blunt trauma lead to in the eye?

Answer 5

periorbital haematoma

sub-conjunctival haemorrhages

hyphaema (blood in the anterior chamber)

traumatic cataracts

subluxation

Retinal tear or detachment

Retinal haemorrhage, acute retinal necrosis

Vitreous haemorrhage

Question 6

What is the treatment of hyphaema?

Answer 6

topical steroids - reduce inflammation

mydriatic pupil - dilate pupile

Question 7

When do blow out fractures occur?

Answer 7

After blunt trauma

Question 8

What happens to the globe in blunt trauma?

Answer 8

globe is weakest at its orbital floor so increased force on the orbit may force the eye through the floor and into the maxillary sinus.

Causes restriction of eye movements, periorbital swelling and potentially ocular damage.
Inferior rectus muscle can become trapped and become ischaemic if pressure is not released

Question 9

What imaging needs to be done for blunt trauma?

Answer 9

X-ray

CT scan

Question 10

How are penetrating injuries managed?

Answer 10

detailed history

X-ray / CT

Question 11

What are the causes of corneal abrasions?

Answer 11

Contact lenses
Foreign bodies
Finger nails
Eyelashes
Entropion (inward turning eyelid)

Question 12

What is the presentation of corneal abrasion?

Answer 12

History of contact lenses or foreign body
Painful red eye
Foreign body sensation
Watering eye
Blurring vision
Photophobia

Question 13

How is corneal abrasion diagnosed?

Answer 13

A fluorescein stain is applied to the eye to diagnose a corneal abrasion. This is a yellow-orange colour. The stain collects in abrasions or ulcers, highlighting them.

Slit lamp examination may be used in more significant abrasions

Question 14

What is the management of corneal abrasion?

Answer 14

same day opthal assessment

Simple analgesia (e.g. paracetamol)
Lubricating eye drops can improve symptoms
Antibiotic eye drops (i.e. chloramphenicol)
Bring the patient back after 1 week to check it has healed
Cyclopentolate eye drops dilate the pupil and improve significant symptoms, particularly photophobia. These are not usually necessary.

Uncomplicated corneal abrasions usually heal over 2-3 days.