Ocular Trauma

Question 1

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

define hyphaema

Answer 2

blood in anterior chamber

Question 3

define hypopyon

Answer 3

white cells in anterior chamber

Question 4

what does a CT of a blow out fracture show?

Answer 4

tear drop or blood level in sinus

Question 5

what blow out fracture can kids get?

Answer 5

white eye blow out fracture

Question 6

presentation of trans-calcarine fracture

Answer 6

dilated pupils

Question 7

presentation of subconjunctival haemorrhage

Answer 7

itchy
red eye
some sclera still see

Question 8

management of subconjunctival haemorrhage

Answer 8

not significant injury as can be spontaneous or trauma (bout of coughing, etc.)

Question 9

what can recurrent subconjunctival haemorrhage indicate?

Answer 9

hypertension

bleeding diathesis

Question 10

management of subconjunctival haemorrhage

Answer 10

should reabsorb within 10-14 days

Question 11

define corneal abrasion

Answer 11

removal of epithelium

Question 12

presentation of corneal abrasion

Answer 12

severe pain due to exposure of nerve endings
lacrimation
sensitive to light (photophobia)
generally miserable
inability to open eye (blepharo-spasm)

Question 13

management of corneal abrasion

Answer 13

topical anaesthetic (oxybuprocaine or tetracaine)
chloramphenicol

Question 14

diagnosis of corneal abrasion

Answer 14

orange fluoresein drops shows abrasion as green in blue light

Question 15

presentation of foreign body in upper eyelid/ sub-tarsal foreign body

Answer 15

gritty eye

Question 16

management of upper-eyelid/ sub-tarsal foreign body

Answer 16

evert the eyelid

Question 17

presentation of corneal foreign body

Answer 17

lacrimation

photophobia

Question 18

examination of corneal foreign body

Answer 18

given topical LA

direct white light

Question 19

management of corneal foreign body

Answer 19

removal

chloramphenicol or fusidic acid

Question 20

define traumatic uveitis

Answer 20

inflammation of the uvea layer

Question 21

presentation of traumatic uveitis

Answer 21

presents 24-48 hours after event

sensitivity to light

Question 22

define commotio retinae

Answer 22

bruised retina

Question 23

corneal laceration presentation

Answer 23

• if pupil is involved it is misshapen

Question 24

diagnosis of corneal laceration

Answer 24

seidel test to assess presence of anterior chamber leakage

fluorescein dye

Question 25

define synechia

Answer 25

iris adhere to either the cornea or lens

Question 26

what conditions is synechia common in?

Answer 26

``` iritis iridocyclitis (or glaucoma) ```

Question 27

process of removing a foreign body from the eye

Answer 27

- slit lamp - LA and edge of needle used to scrap or scoop - cover with chloramphenicol after

Question 28

what should raise suspicion of penetrating foreign body

Answer 28

pupil irregular anterior chamber shallow localised cataract gross inflammation

Question 29

management of intra-ocular foreign body

Answer 29

always XR | fast moving particles / high velocity trauma

Question 30

two types of burns

Answer 30

1. alkaline | 2. acid

Question 31

describe alkaline burn

Answer 31

``` rapid penetration cicatrising changes to conjunctiva and cornea penetration of intra-ocular structures ischaemia around limbus china white eye ```

Question 32

describe acid burn

Answer 32

coagulates proteins little penetration inflamed, cloudy cornea

Question 33

end stage of burn

Answer 33

scarring and adhesions

Question 34

why is it difficult for corneal to heal?

Answer 34

avascular

Question 35

management of burn

Answer 35

1. history= chemical, when (be aware of lime/ cement) 2. check pH and irrigate (minimum 2L saline until pH normalises) 3. assess with slit lamp