Ocular trauma

Outline

ocular trauma

Ⅰ. mechanical factors

Ⅱ.physical factors Ⅲ.chemical factors

Classification

• Causative factors of injury

– Mechanical ocular trauma

– Non-mechanical ocular trauma

• Degree of injury

– Microtrauma

– Moderate injury

– Macrotrauma

Outline New classification• Ocular trauma

Close Open

Contusion

Laminar laceration

Rupture

Penetration

Foreign body

Penetration-through

Laceration

Examination

• Examination of ocular trauma

– History

– General condition

– Visual acuity

– Extra-eye examination

– eyeball examination

– Assist examination

Treatment

• Treatment

– to rescue life

– chemical injury —— to rinse with mass

of water

– Open injury—— TAT

– Penetration injury—— to avoid pressure

– Reasonable antibiotics

Ocular contusion

• Ocular contusion ： caused by mechanical blunt

force

• > 1/3 ocular trauma

• Causative factors of injury

– Blunt body

– High-pressure gas ／ fluid

– Blunt force conduction —— indirect injury

Ocular contusion

§ Corneal Bruise§ Iris and Ciliary Body Bruise Iris injury and pupil abnormityIris injury and pupil abnormity Hyphema§ Lens Bruise§ Vitreous hemorrhage§ Choroid Bruise§ Retinal Commotion and Bruise

Corneal Bruise

• Clinical manifestation and treatment

– Superficial lamella abrasion —— antibiotic

ointment ＋ eyepatch and to avoid topical

anaesthesia

– Corneal stroma injury—— glucocorticoid ，

mydriasis when necessary

– Corneal rupture —— suture

Corneal Bruise

Iris and Ciliary Body Bruise

• Trauma Trauma iridocyclitis• Clinical manifestationClinical manifestation

– diminution of vision ，， irritation– ciliary congestion– Iris edema, Iris edema, blurred texture– Tyndall’s signTyndall’s sign– KPKP

• Treatment Treatment – Glucocorticoid ／／ NSAID– Mydriatic

Iris and Ciliary Body Bruise

Iris and Ciliary Body Bruise

Iris injury and pupil abnormityIris injury and pupil abnormity

Iris and Ciliary Body Bruise

clinical manifestationclinical manifestationHyphema

Iris and Ciliary Body BruiseHyphema

• Treatment

– Semi-reclining position and resting

– Double eyepatch

– No Myosis nor Mydriasis

– Cold pack first and then hot pack

– Sedation

– Hemostatic drug

– Operation —— high IOP

Lens Bruise

Change of lens transparence ——

Traumatic cataract

Treatment

Operation

Lens Bruise

Change of lens position

• Treatment

– Operation

Vitreous hemorrhage

Vitreous hemorrhage

• Treatment

– A little —— Self-absorption

– No absorption more than 3 months

—— Vitrectomy

– Retinal detachment —— Operation

Choroid Bruise

TreatmentTreatmentNo special treatmentNo special treatment

Retinal Commotion and Bruise

Ocular rupture• Clinical manifestation

– IOP

– Hyphema /vitreous hemorrhage

– Subconjunctival hemorrhage

or hematom

– Corneal deformation

– Limitation of eyeball movement

– VA —— no LP

• Treatment

– Exploration

– treatment

Ocular Penetration

Ocular Penetration

• Complications

– Traumatic iridocyclitis

– Intraocular foreign body

– Infectivity endophthalmitis

– Sympathetic ophthalmia

– Traumatic PVR

Ocular Penetration• Basic principle

– To Rehabilitate wound in time and recover ocular

integrity

– To prevent and treat infection and other

complications

• Operation ： primary or secondary

• antibiotics ： local ／ general

• Atropine

• Glucocorticoid ／ NSAID ： local ／ general

Ocular Penetration

Foreign Body

Extraocular Foreign Body

Intraocular Foreign Body

Intraocular Foreign Body

• Treatment principle

– Diagnosis in time and operation at

the right moment in order to keep

and recover vision

Ocular Appendix Trauma

Eyelid Trauma

Orbital Trauma

Chemical Burn

Chemical BurnBase burn

– Tissue lysis ， easy pervasion and

severe

– Blurred circumscription ，

progressive

– corneal epithelium exfoliation ：

usual

– blood vessel invasion ： obvious

– necrosis ： pervasion to deep

– Intraocular damage ： yes

Acid burn

– coagulation necrosis ， reduce pervasion ， not severe relatively

– Clear circumscription ， no progressive

– corneal epithelium exfoliation ：occasional

– blood vessel invasion ： no obvious

– necrosis ： limit to contact surface

– Intraocular damage ： little

Chemical Burn

Chemical Burn• First aid ： to rescue in time

– To disengage chemical contact immediately and rinse in locale as soon as possible ： mass of water ， long time

– Neutralization ： acid —— 2 ％ Sodium bicarbonate, sulfadiazine base —— Vitamin C

• Infection prevention ： antibiotic

• To promote healing ： epidermal growth factor ， Vitamin C

• prevention and cure symblepharon and other complication

– mydriasis : Atropine

– glucocorticoid

– Collagenase inhibitor

– Tear Substitute ／ contact lens

• Complication Treatment ： Operation

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