Eye injury

Types

Blunt trauma

Penetrating trauma

FB

Radiation

Thermal injury

Chemical injury

Blunt Trauma

By Fist , Tennis ball

Mechanism :

Coup Countercoup ( at site , distanat damage dt shock waves )

Anteropost. Compression , horizontal expansion.

Effect : 1) orbit :

Proptosis : dt

Retrobulbar hge

Peribulbar air

Enophthalmos : increase intra orbital pr escape of orbital fat and ms in

maxillary sinus vertical diplopia , loss of sensation in LL

Ttt: surgical repair by bone ships

ophthalmoplegia

Orbital Fracutres

Fracture orbital floor

Fracture of medial wall

Fracture of lateral wall

Fracture of orbital roof

Effect : 2) Lid

Ecchymosis ( Black eye )

TTT : cold compression 1n 24h then Hot foment if not surgical evacuation

Emphysema ( dt ethamoid or maxillary sinus Fracture )

Ptosis dt :

Mechanical dt increase weight

Paralytic : injury of levator ms

Ttt L manage hematoma \ wait 6 m and asses function of levator

Wounds :

Vertical : Gapping extensive scar ectropion , lagophthalmos

Horizontal : no gap heal with less scar

Canlicular laceration : repaired by silicon tube

Ttt : wash \ AB \ Debridement and suture

Effect : 3) Conjunctiva

Wounds

Sub conj hge dt :

Direct by trauma

Fracure base of skull ( bilateral , panda eyes )

chemosis

Effect : 4) Cornea

Abrasion

Endothelial damage : cause stromal edema

Wounds rupture of globe iris prolapse

Blood staining cornea dt hyphema

TTT : Reposition and suturing

increase IOP Reddish cornea

TTT : control IOP + ttt of hyphema

Recurrent erosion dt imperfect healing of BM

Effect : 5) sclera

Rupture globe: sign

Decrease visual Acuity and IOP

Shallow or flat AC

Alternation in pupil size , shape and location

Focal iris transillumination

Focal iris corneal adhesion

Corneal lens track

Acute lens opacity

Chemosis or subconj hge

Deer eye lid laceration

Effect : 6) Lens :

Sublaxation

Dislocation

Traumatic cataract + Vossius ring

Effect : 8) AC

Ant dislocation : pupillary block glaucoma

Hyphema :

Blood from CB , iris

Fate :

Absorbtion

Complication : glaucoma \ stain cornea

iridocyclitis \ rebleeding
Ttt : rest \ bandage

Monitor IOP

L : steroid , BB#

G : Aminocaproic acid , vit c , Ambezym

Surgical evacuation by paracentesis or IA

Effect : Pupil

Traumatic miosis : transient dt 3rd nerve irritation spasm of ms

Traumatic mydriasis : transient or permanent

dt damage of 3rd n paralysis of ms

may associated with paralysis of accommodation

Adie Pupil

Effect : Iris

Traumatic iridocyclitis

Pupillary laceration :

V- shaped laceration

May associated with Anti flexion or retroflexion

Iridodenesis ( Tremulous iris ) dt sublaxation or dislocation of lens

Traumatic aniridia : complete avulsion of iris at its root

TTT : colored Cl

Iridodyalsis : separation of iris root from CB

Cause uniocular diplopia , D-shaped pupil , Associated with hyphema

TTT :

If diplopia : suture

Iridectomy + ttt of iritis

if no diplopia : Atropine , cortison

Effect : CB

Hypotony dt CB shock

Glaucoma : dt CB laceration from hypotony , healed by fibrosis close ange

Spasm of accommodation temperory myopia

Paralysis of accommodation

Intra ocular hge : hyphema , vit. Hge

Effect : Choroid

Choroidal effusion or hge RD

Choroidal rupture :

Temporal , crescenteric m Red then white

Crossed by retinal Vs

TTT : Rest , vit c

Traumatic choroiditis

Choroidal detachemnt

Effect : Vitrous

Vitrous hge

Vitrous opacification dt Hge and coagulated protein

Vitrous loss through Rupture globe with retinal traction

Effect : Retina

Retinal tear -- RD

Traumatic macular hole dt vitrous traction

Retinal hge : intra retinal and subhyaloid hge

Retinal edema ( commotion retina )

Retinal detachement

Tractional : dt vitrous loss in scleral wound

Exudative : dt hypotony

Rhegmatogenous : dt retinal tear

Effect : optic n.

Avulsion : dt extreme torsion

Optic n. hge

Optic n edema with hypotony

Optic atrophy

EOM : ophthalmoplegia
Lacrimal :
lacertion : epiphora
gland displacement
IOP :
Traumatic glaucoma : dt corneal ulcer , irits , hyphema
Traumatic hypotony : dt CB shock , iridocyclitis , Rupture globe

Effect : Refraction

Myopia dt spasm of ciliary ms

Loss of Acoomodation dt paralysis of ciliary ms

Astigmatism dt lens sublaxation

Aphakia dt post. Dislocation of lens

Shaken baby syndrome

caused principally by violent shaking, often in association with impact

injury to the head

rotational acceleration and deceleration of the head, in contrast to the

linear forces generated by falls

brainstem traction injury causes apnoea, consequent hypoxia leading to

raised intracranial pressure and ischaemia.

C\P : irritability , lethargy , vomiting

Systemic : skull fracture , skin brusies , Subdural or subarachnoid hge

Ocular : periocular brusies , Retinal hge , poor VA with APD , loss of

vision

Penetrating trauma

Caused by sharp object ( knife , scissor )

Effect depend on extent of injury

Cause : cut wound in lid , cornea , sclera , lens ,

uveal prolapse or vitrous loss

Infection : endo or panophthalmitis

Sympathatic ophthalmitis

Extra ocular FB

Site : cornea , sulcus subtarslais , lacrimal punctum

Effect : corneal ulcer and opacity

TTT : removal by piece of cotton or needle

AB , cyclopentolate , soft Cl

Intra ocular FB

Effect : glass surrounded by fibrosis

Iron : sidrosis

Copper : chalcosis

Diagnosis History , slit , fundus , X-ray , U\S . CT

TTT :

Removal of FB :

If in AC or on iris : limbal incision , use forceps

If entangled in iris : iridectomy

Lens : Extraction

Post segment : vitrectomy , forceps extraction

AB + Atropine + enucleation if no PL

Chemical injury

Acids : sulphoric , battery fluid

Alkaies : KOH , NaoH

Corrosive lime , aniline dye

Chemicals Iodine , war gases

Effect

Depend on conc , duration , Extent to limbus

Alkalies : cause cell disruption , dissolve corneal stroma - penetrating eye

Necrosis of conj Bl vs ---- porcelain white apperance

Acids : localized damage --- ppt and coagulate at epithelial level that act as
barrier

C\P : Pain , lacrimation , blepharospasm , photophobia , decrease of vision

Effect

Lid : edema , Hge , .

Conj : ulcer , chemosis

Cornea : edema , ulcer , SPK

Uvea : Uvitis

IOP : may increase

TTT

1st aid :

Copious irrigation water or saline 20 min

If nature known :

Acid : wash by NahCO3

Alkalies : Boric acid

Iodine : wash with starch or milk

Lime : EDTA

Aniline : Alcohol

Local : AB , Atropine , soft CL , LA , CAI

General : AB , vit C,A , steroid , analgesic

Ttt of complication

Radiation :

Infra red Rays :

Glass blower cataract

Iron melters cataract

Eclipse blindeness : macular hole

X-ray : madarosis , cataract , Retinopathy

Ultraviolet : photophthalmia , epithelial punctate keratits

Ttt : Bandage , AB , LA , cycloplegic

Electrical : complicated cataract cAnt Uvitis

Thermal

Molten metal , dry burn , hot water , liquid

Ttt : as chemical injury