Ocular Trauma
Sandra M. Brown, MD
Associate Professor
Ophthalmology and Visual Sciences
Nature of Injury
• Blunt
• Lacerating
• Chemical
Blunt Trauma
• Mild – moderate– “bruise” ocular tissues– Eye wall intact
• Moderate – severe– Rupture eye wall– Very severe consequences
Lacerating Trauma
• “cut” eye wall
• Outcome depends on extent and location
Location of Injury
• Anterior Segment
• Posterior Segment
• Adnexa
• Orbital Structures
Anterior Segment
• Conjunctiva
• Cornea
• Iris
• Lens
Posterior Segment
• Vitreous
• Retina
• Optic nerve
Adnexa
• Eyelids
• Lacrimal Structures
Orbital Structures
• Extraocular muscles
• Bony walls
Disgusting Photographs
• Front to back…
Subconjunctival Hemorrhage
Corneal Foreign Body
Curling Iron Burn
Corneal Laceration
Iris Sphincter Rupture
Traumatic Cataract
Vitreous Hemorrhage
Retinal Hemorrhage
Optic Disc Hemorrhage
Orbital Wall Fracture
Common Minor Eye Injuries
• Corneal abrasion
• Corneal foreign body
• Chemical splash
• Traumatic iritis
Diagnosis
• History– Sharp vs blunt vs chemical injury
• Exam– CHECK VISION– CHECK VISION– CHECK VISION
Diagnosis cont.
• Exam – Pry lids apart!– Cornea clear?– Pupil round?– Pupil black?– Blood clotted behind cornea?
Diagnosis cont.
• Exam– Red reflex?– Eyes move symmetrically?
Fluorescein Test
• Topical “eye dye”
• COBALT light
Abrasion Treatment
• Erythromycin ointment
• +/- patch
• 1-2 day follow-up with eye doc
Corneal Foreign Body
Foreign Body Treatment
• Anesthetize eye
• Remove FB– Cotton swab (don’t worsen abrasion!)– Kimura spatula– +/- needle tip
• E-mycin and +/- patch
• 1-2 day follow-up with eye doc
Chemical Treatment
• IRRIGATE
• Check pH
• Minor– E-mycin ointment– 1 day follow-up eye doc
• Major– Same day eval by eye doc
Traumatic Iritis
• Moderate blunt injury
• Photophobia
• Lid bruising/edema
• Subconj heme or injection
• Pupil sluggish
• Eval by eye doc
Please Do Not Confuse
• Subconjunctival hemorrhage
• Hyphema