Refractive and Adnexa Conditions

That Can Be Caused by Trauma

Traumatic myopia
Transient myopia that can occur after blunt ocular
trauma
Traumatic myopia tends to resolve without
treatment
Periorbital ecchymosis "black eye,"
blood accumulation in the eyelids,more noticeable
in the lower lid , forms an organized hematoma or
firm purplish-black mass

Treatment
cold compress intermittently for the first 48 hours,
followed by hot packs for 3 to 5 days thereafter

Eyelid lacerations
Superficial lacerations : clean the wound, irrigate,
remove any foreign material, apply AB ointment
and sterile dressing
Deeper lacerations : sutures
Complicated lacerations : oculoplastics consult

Anterior Segment Conditions That

Can Be Caused by Trauma

Subconjunctival hemorrhages
do not require treatment, resolve in 1 to 2 weeks

Conjunctival abrasions
-Produce fluorescein staining, subconjunctival
hemorrhage
-AB eo TID for 4 to 7 days, pressure patching for
24 hours
-Suturing, heal without surgical repair

Corneal and conjunctival foreign bodies

asymptomatic, mild to moderate eye pain
inspect the fornices thoroughly and evert the
eyelids

Corneal abrasions
Seidel test History of rubbing or scraping the cornea
Treatment
Small to moderately: fairly tight-fitting bandage
lens + AB Large abrasions
: pressure patch +
AB
Cycloplegics and analgesic

Corneal laceration
Cutting or tearing the cornea
Seidel test can be crucial
Partial-thickness : treat like a corneal abrasion
Moderate to deep :

suturing

Full-thickness : treat like a ruptured globe

Moderate and Full - Ophthalmologist

Chemical burns
Affect multiple ocular structures,potentially cause
blindness
Alkaline : hydrophilic and lipophilic
rapidly penetrate cell membranes
saponification,cell death
disruption of the extracellular matrix

Acidic : less damage , coagulated tissue

Whiter eyes are more alarming then red eyes
Management :
begin irrigation as soon as possible
cycloplegic, AB eo, artificial tears, steroid topical,
oral
Vit C , Diamox, pressure, amnion membran

Hyphema

Layering of RBCs in the inferior anterior chamber

Management :
Hospitalization during the most critical time for
clot formation; about 5 to 7 days after the injury.
Discontinuing elective anticoagulants
Patient's head should be elevated 30
Antifibrinolytic agent, steroids
Surgical evacuation of the clot

Complication
3.5 to 38% of patients rebleed, 2 to 5 days after
about 30% have temporarily elevated IOP for 5 to
7 days
5% require surgical intervention
about 75% demonstrate some degree of angle
recession or iridodialysis
only 5% will develop secondary glaucoma.

Hemosiderosis
cornea becomes stained by blood
prolonged hyphema
elevated IOP
endothelial damage

Iridodialysis
Detachment of the iris root from the ciliary body
Produce corectopia (irregular pupil shape),
pseudo polycoria, and diplopia
Monitor for glaucoma
Treatment :opaque soft contact lens with a clear
pupil

Traumatic cataract

Lens subluxation

Anterior Lens Dislocation

Posterior Lens Dislocation

Globe And Orbit Conditions That

Can Be Caused By Trauma

Intraorbital foreign body

High-velocity periocular injuries
Inorganic IOrbFBs and Organic
Anti-tetanus prophylaxis and a broad-spectrum
oral antibiotic
Surgical removal is indicated

Intra Orbital Foreign Body

Globe Rupture

Globe rupture
The signs
Severe subconjunctival hemorrhage
Deep or shallow anterior chamber, hyphema,
irregularly shaped pupil , exposed uveal tissue
(appears brownish-red), an EOM restriction
,hypotony
Management
Suture, Eviseration

Globe Rupture

Retrobulbar hemorrhage
Orbital vessel ruptures and leaks blood products
into the orbit

The sign
non-pulsating exophthalmos
resistance to retropulsion, elevated IOP
EOM restriction, central retinal artery pulsation ,
choroidal folds, and possibly optic neuropathy
Treatment
Decrease IOP
Immediate surgical lateral canthotomy and
cantholysis to reduce orbital pressure
Orbital decompression

Arteriovenous fistulas
High-flow fistulas : traumatic basal skull fracture
The Signs
audible orbital bruit, pulsatile proptosis,
chemosis, orbital swelling, elevated IOP,
ophthalmoplegia, and retinal vessel congestion

Low-flow fistula
Insidious onset , not usually caused by trauma
associated with hypertension , arteriosclerosis
The signs
Mild orbital congestion , proptosis, low or no
orbital bruit, and normal to elevated IOP.

Low-Flow Arteriovenous fistula

Orbital fractures
Common cause :

Blunt trauma

The signs
Crepitus or subcutaneous emphysema
Muscle entrapment and/or a nerve palsy ,
decrease facial sensitivity

Vitreous And Retinal Conditions

That Can Be Caused By Trauma

Intraocular foreign body

Commotio retinae / Berlins Edema

Pre-retinal hemorrhage

Choroidal rupture

Traumatic macular hole

Purtscher's retinopathy

Traumatic Retinal
detachment

Traumatic retinal detachment

Traumatic optic neuropathy

Optic nerve avulsion