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(2) Tri A Visual Ergonomics > Week 6- Ocular Trauma:- > Flashcards

Week 6- Ocular Trauma:- Flashcards

1
Q

Incidence of ocular trauma:- scotlanc/usa

A

• Scotland Incidence of trauma: 5million pop/428 admisions 1991-1992
- Incidence 1.96 per 100k

• US: 2.4m eye injuries annually, 1m permanent significant visual impairment, 75% blind in one eye
- Second most common cause of visual impairment after cataract

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2
Q

Ocular trauma classification:-

A

•Non-mechanical trauma:
- Chemical
- Thermal
- Electrical
- Radiation
• Mechanical Trauma:
- Contusion
- Perforation

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3
Q

Mechanical Injury Clinical classification:-

A

• Closed Globe
- Contusion
- Lamellar laceration

• Open Globe
- Lacerations
~ Penetrating
~ Perforating
~ IOFB
- Rupture

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4
Q

Eye trauma Glossary definitions:-
• Eyewall
• Closed globe
• Open globe

A

• Eyewall - Sclera and Cornea
• Closed Globe - No full thickness wound of eyeball
• Open globe - Full thickness wound of eyeball

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5
Q

Eye trauma Glossary definitions:-
• Contusion
• Lamellar laceration
• Rupture

A

• Contusion: No full thickness wound
• Lamellar laceration: Partial thickness wound of eyewall
• Rupture: full thickness wound of eye-wall, caused by blunt object

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6
Q

Eye trauma Glossary definitions:-
• Laceration
• Penetrating Injury
• Perforating Injury

A

• Laceration: Full thickness wound of eye-wall, caused by sharp object
• Penetrating Injury:
- Entrance wound
- Retained foreign object/s
• Perforating Injury
- entrance and exit wounds: causes by same agent

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7
Q

Severity can be classified by and factors:-

A

• Mild to severe
• Risk of blindness
• Risk dependent on number of factors:-
- Type of injury
- Time passed before treatment initiated (e.g chemical)
- ocular structures affected

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8
Q

Chemical Injury:-

A

• Most destructive
• Occur at work or home
• Severity depends on form of chemical:-
- Liquid, vapour, gas or solid.
• Extent of damage depends on time of exposure
• 2/3 occur at home
- Usually accidental

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9
Q

Chemical injury - Types

A
  1. Alkalis - cleaning substances
  2. Acids - car batteries
  3. Organic solvents - Units in paints etc
  4. Surfactants (wetting agents): in soaps and detergents
  5. Aerosols: powders, or droplets, suspended in a gas
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10
Q

Alkali Burn:-

A

• Most severe
• Alkalis tend to penetrate tissue deeper than acids
• Alkali injuries twice as common as acid burns
• Alkali commonly used in household cleaning agents

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11
Q

Alkali Injury Grading:-

A
  • Grade I - Clear cornea, no limbal ischemia
  • Grade II - Hazy cornea, visible iris, < 1/3 limbal ischemia
  • Grade III - Opaque cornea, stromal haze, iris details obscured, 1/3 - 1/2 limbal ischemia
  • Grade IV - Opaque cornea, iris details obscured, > 50% limbal ischemia
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12
Q

Acid burns:

A

• Potentially less severe than alkali
• Do not affect deeper tissue layers
• Clinical features are generally similar to alkali injuries:
- lid oedema (swelling)
- generalised redness
- Small conjunctival haemorrhages
- Conjunctivitis
• Prolonged exposure may cause:
- ulceration and opaqueness of corneal and conjunctival epithelium
- Permanent haze and vascularisation

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13
Q

Organic solvents:-

A

Do not usually cause permanent damage
May cause:
- Irritation
- Punctate keratitis (epithelial)
- Stromal damage
- Lacrimation
- Pain
- Photophobia
- Stinging

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14
Q

Chemical injury - Management

A

• emergency treatment
• Irrigation is vital
- Neutralise pH before history, with copious irrigation, using saline 15-30mins, if not tap water. Evert eyelids, remove particles and apply topical anaesthetic for comfort

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15
Q

Chemical Injury - Treatment by medicine (5)

A

• Topical antibiotics such as Prophylaxis
• Topical steroids to reduce inflammation: but reduces healing
• Topical cycloplegia
• Topical lubricants
• Oral analgesia
All topical treatment should be preservative free if possible

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16
Q

Chemical Injury - Alternative Treatment: (3)

A

• Elevated IOP : treatment indicated
• Ascorbic acid (topical and systemic) improves wound healing
• Topical citric acid (sodium citrate) - inhibits neutrophil activity, reduces inflammation
• Surgery, e.g penetrating keratoplasty for opaque corneas

17
Q

Blunt Trauma:-

A

• Often caused by flying blunt obiects
• Rugby/ football injury - elbow
• Ocular damage may be the result of wave forces travelling through the liquid contents of the eye
• This may cause an explosive force within the globe
• Commonly associated with more complex injuries

18
Q

Blunt trauma - clinical features: Anterior segment

A
  • Corneal abrasion
  • Corneal oedema
  • Hyphaema
  • Miosis
  • Mydriasis
  • Cataract
19
Q

Blunt trauma - clinical features: Posterior segment

A
  • Posterior vitreous detachment
  • Retinal oedema
  • Retinal breaks
  • Macular holes
  • Choroidal rupture
  • Traumatic optic neuropathy
20
Q

Traumatic Optic Neuropathy:-

A

•Caused by transmission of force through the orbital bones due to a trauma to the orbit, forehead, or brow:
- shearing of optic nerve fibres
- haemorrhage
- optic nerve oedema
- vision loss

21
Q

Fractures of the orbit:-

A

• Caused by blunt trauma
• Involved broken orbital bones
• Symptoms include:
- Swelling of eyelid
- Bruising around the eye
- Eye pain
- Double vision
- Reduced motility of the affected eye

22
Q

Fracture of orbit: Blow-out fracture:-

A

• Specific type: Blow-out fracture:
- Orbital floor or medial wall affected
- Muscle may get trapped in fracture
- Motility problems, esp. when looking up
- Diplopia possible
- Painful
- Patient may have nosebleed

23
Q

Blunt trauma - management

A

• Primary repair globe
• Secondary: surgical repair of iris, lens or other affected structures
- All HES

24
Q

Anterior segment of eye - Damages to cornea, conjunctiva, anterior chamber, iris and lens examples

A

• Cornea:
- Superficial foreign body (common)
• Conjunctiva:
- Sub conjunctiva haemorrhages can occur, not sight-threatening, referral not essential
• Anterior chamber:
- Hyphaema is potentially more serious
- May cause secondary glaucoma
• Iris:
- Iris damage may give rise to traumatic mydriasis or traumatic miosis (temporary or permanent)
- Patients may experience glare
- Angle recession and glaucoma may develop
• Lens
- Dislocation possible

25
Q

Ocular foreign bodies:- causes

A

• Dust, sand or paint
• Superficial FB: sticks front of eye
• May get trapped under eyelids
• Possible causes:-
- Grinding
- Working under car
- Windy day
• Superficial FB not serious

26
Q

Ocular foreign bodies:- Clinical features, (Symptoms, signs, diagnosis)

A

• May cause corneal abrasion
• Symptoms:
- Ocular irritation, pain, photophobia, tearing
• Signs:
- Conjunctival injection
• Diagnosis:
- Slit lamp
- Corneal staining with fluorescein?

27
Q

Ocular foreign bodies:- Clinical features,
(Treatment, aim, prognosis)

A

•Treatment:
- Remove FB (e.g. cotton bud)
- Topical anaesthetic if required
- Artificial tears, topical cycloplegic, antibiotic eye drops/ ointment
• Aim: rapid epithelial healing
• Prognosis: usually good

(2) Tri A Visual Ergonomics (11 decks)

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