Trauma

Question 1

How should you assess a patient presenting with trauma?

Answer 1

Good history of the incident
Visual acuities - this is important as it allows you to quiantify the extent of damage
Examination of the eye - lids, conjunctiva, cornea, anterior segment, pupils, fundus
Use fluorescein drops - to identify area of epithelial loss

Question 2

Why is corneal abrasion so painful?
What happens to the pupil?
Treatment?

Answer 2

• Cornea is highly innervated
• When you abrade the epithelium you expose the nerve endings
• Pupils goes into spasm, get headache
• Treat with chloramphenicol ointment

Question 3

What are the six golden rules of ocular trauma?

Answer 3

1. History is key
2. Always record visual acuity
3. Don’t forget Fluorescein
4. Handle suspected globe rupture with care
5. X-Ray orbits if suspicion of Intra-Ocular Foreign Body (IOFB)
6. Immediate irrigation of chemical injuries (the solution to pollution is dilution!)

Question 4

Describe the pathology in blow out # and how this can affect the eye muscles

Answer 4

Herniation of orbital contents inferiorly – orbital fat through the #, can also get tethering of inferior rectus -> unable to look up as the muscle is caught and causing resistance

Question 5

What is the common condition called when a blood vessel leaks and the sclera turns red?

Answer 5

Subconjunctival haemorrhage

Question 6

What should you suspect if you see white cells in the anterior chamber on slit lamp?
How does is present?

Answer 6

Anteior uveitis
Blurred vision, slightly red eye

Uvea - iris, ciliary body, choroid

Question 7

What is hyphaema?

Answer 7

Blood in the anterior chamber

Question 8

Give a cause of an irregular shaped iris in trauma

How can you investigate this?

Answer 8

Corneal laceration - aqueous can leak through the wound
The iris then moves into the space to block the gap
Put in Fluorescein drops - if open wound with aqueous pouring out, you’ll get dilution of the fluorescein

Question 9

What is sympathetic ophthalmia?
What can it lead to?
Rare or relatively common?

Answer 9

Penetrating injury to one eye causes exposure of intra-ocular antigens -> auto-immune reaction in both eyes -> inflammation in both eyes
May lead to bilateral blindness (from a unilateral injury)
Essentialy an autoimmune reation in both eyes
Extremely rare - but is very important and must always be remembered

Question 10

In which layers of the eye can small objects lodge?

Answer 10

Sub-tarsal
Conjunctival
Corneal
Intra-ocular
Intra-orbital

Question 11

How should you manage corneal foreign body?

Answer 11

Use anaesthetic
Use the edge of a needle as a spade to lift it off
You will have left an abrasion on the cornea – chloramphenicol ointment 4/daily for a week

Question 12

Give four signs that should make you more think of a penetrating foreign body

Answer 12

1. Pupil irregular
2. Anterior Chamber shallow
3. Localised cataract
4. Gross inflammation

Question 13

What investigation should you always do for intra-ocular foreign bodies?

Answer 13

X-ray

Question 14

Give some characteristics of ocular burns from acid vs alkali

Answer 14

Alkali 
- Easy, rapid penetration
- Cicatrising changes to conjunctiva and cornea
- Penetrates the intra-ocular structures
Acid 
- Coagulates proteins 
- Little penetration

Question 15

What do you see on examination of alkali burn?

Answer 15

Evidence of ischaemia at the limbus - lack of vessels -> china white appearance

Question 16

How should you assess a chemical injury?

Answer 16

Quick history
- Nature of chemical, when, irrigation at event…
- Beware Lime / Cement
Check Toxbase if available
Check pH
Irrigate +++ (minimum of 2l saline, or until pH normal)
Then assess at slit lamp