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Corneal laceration

Partial thickness vs Full thicknessThe Ant. Chamber isnt entered, therefore, the cornea isnt perforated.

A full-thickness injury will allow aqueous humor to escape the anterior

chamber, which can result in a flat-appearing cornea, air bubbles under

the cornea

Workup1.Complete ocular examination

2.Seidel test. If positive then its a full-thickness laceration.

Seidle test: is used to assess the presence ofanterior chamberleakage in

the cornea.

http://en.wikipedia.org/wiki/Anterior_chamberhttp://en.wikipedia.org/wiki/Corneahttp://en.wikipedia.org/wiki/Corneahttp://en.wikipedia.org/wiki/Anterior_chamber

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+ve seidle testRiver Sign

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Corneal lacerations cont.1. Cycloplegic agents to relieve the pain .atropine, cyclopentolate, homatropine, scopolamine

2. If moderate to deep corneal laceration is accompanied by wound gape, it is

often best to suture.

3. Tetanus toxoid for dirty wounds.

4. Antibiotic .

Reevaluate daily until the epithelium heals.

http://en.wikipedia.org/wiki/Atropinehttp://en.wikipedia.org/wiki/Atropine

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HyphemaBlood in the Anterior Chamber.

The source of bleeding is usually a tear in the anterior face of the

ciliary body. Or iris .

Symptoms:

Pain, Blurred vision, History of blunt trauma

Signs:

Blood in the Anterior Chamber. Gross layering or clot or both, usually

visible without a slit lamp. A total (100%) hyphema may be black or red;

when black its called 8-ball or black ball hyphema.

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Hyphema cont.Treatment1. Complete bed rest or hospitalization2. Place a shield over the injured eye

. Elevation of the head of the bed byapproximately45 degrees (so that the hyphema can settle outinferiorly and avoid obstruction of vision, as well as tofacilitate resolution3. Atropine4. Mild analgesics

5. Topical steroids drops (Traumatic iritis develop 2-3days)6. NO aspirin or NSAIDs

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Why we treathyphemia ?

To aviod its complications :1- irreversible blood-stainedcorneal endothelium ..thecornea will lose itstransparency.

2- raised intra-ocular pressuredue to iridocorneal angleoblitration with blood .

3- synechiae ( adhesions ) :

* anterior (iris cornea).

* posterior ( iris lense ) .

Factors with pooroutcome:

1. Poor visual acuity

(worse than 20/200)

2. Sickle cell disease/trait

with increased IOP

3. Medically uncontrollable

IOP

4. Large initial hyphema

5. Recent Aspirin, NSAIDs

use

6. Delayed presentation

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Lens subluxation \ dislocation

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Defenition

Incomplete rupture of the zonule with the displaced lens remaining

behind the pupil . In dislocation, or complete rupture , the lens is

displaced forward into the anterior champers or backward into

the vitreous body

When congenital, this condition is known as ectopia lenitis .Causes

1. Trauma most common cause

2. Marfan Syndrome

3. Homocystinuria

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Signs & symptoms

SymptomsDecreased vision, double vision that persists when covering

one eye (monocular diplopia)

SignDecentered or displaced lens,. Marked astigmatism,

Cataract, Angle-closure glaucoma as a result of pupillary

block, acquired high myopia, viterous in the ant. Chamber,

asymmetry of the ant. Chamber depth

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Teatment :

Depend if the vision is affected or not :

>> if affected : syrgical removal of the lense and replace it by an artificial

one

>> not affected : no treatment . Just observe .

>> if dislocated to the ant. Chamber: immediate removal of the lens

because it will rise the intra ocular pressure

Complications:Glucoma due to papillary block .there is a communications b\w ant.& post.

Champers via the pupil in the gap b\w iris & lens at the pupil margin .

It this angle is blocked pressure in the post. Chamber pushes the iris forward

and may close the angle>>>>> acute closed angle glaucoma .

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Blowout fractureis a fracture of the walls or floor of

the orbit. Intraorbital material may bepushed out into one of the paranasal

sinus This is most commonly caused by

blunt trauma of the head

Common medical causes of orbitalfracture may include:

Direct orbital blunt injury

, tennis ballsquash ballSports' injury (

etc.)

Motor vehicle accidents

http://lifeinthefastlane.com/2010/08/ophthalmology-befuddler-014/http://lifeinthefastlane.com/2010/08/ophthalmology-befuddler-014/

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mechanism causing blow out fracture:

Buckling theory:

This theory proposed that if a force strikes at any part of the orbital rim, these forces gets

transferred to the paper thin weak walls of the orbit (i.e. floor and medial wall) via rippling

effect causing them to distort and eventually to fracture. This mechanism was first described

by Lefort.

Hydraulic theory:

This theory was proposed by Pfeiffer in 1943. This theory believes that for blow out

fracture to occur the blow should be received by the eye ball and the force should be

transmitted to the walls of the orbit via hydraulic effect. So according to this theory for blow

out fracture to occur the eye ball should sustain direct blow pushing it into the orbit.

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Signs and symptoms- Symptoms:

Pain (especially on attempted vertical eye movement)

Local tenderness

double vision

Eyelid swelling

And creptius after nasal blowing

- Sign:

- 1. Periorbital ecchymosis (very commonly seen in blow out

fractures)- 2. Disturbances of ocular motility

- 3. Enophthalmos

- 4. Infraorbital nerve hypoaesthesia / anesthe

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Restriction on upgaze due to trapping of the

inferior rectus muscle by connective tissue septacaught in the fractured site.

The inferior orbital floor is the most commonly fracturedsite.

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Investigation :ct scan

x-ray : tear drop sign .-(most adult orbital fractures can initially be followed

conservatively)*Broad spectrum oral antibiotic (may be use but not mandatory)*Instruct the patient not to blow his nose

*Apply ice packs to the orbit for the first 24 to 48 hoursThe aim of treatment is prevention of permanent diplopia and cosmeticallyunacceptable enophthalmos.The factors that determine the risk of late complications are

-Fracture size-Herniation of orbital content into the maxillary sinus

-Muscle entrapment

*Surgical repair-Immediate repair (usually within 24hr.)-Repair in 1 to 2 weeks

*Neurosurgical consultation is recommended

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Commotio retinae:Concussion of the retina

that may produce a milkyedema in the posteriorpole that clears up after a

few days.Symptoms

Decreased vision orasymptomatic, history of

recent ocular traumaSigns

Confluent area of retinalwhitening

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Commotio retinae cont.Workup

Complete ophthalmicexamination, includingdilated fundusexamination. Scleraldepression is performedexcep when a hyphema,or iritis is present

TreatmentNo treatment is requiredbecause this condition

usually clears withouttherapy

Follow up

Dilated fundusexamination is repeatedin 1-2 weeks.

( )

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Chemical burn (injury) Chemical exposure to any part of the eye or eyelid may result in a

chemical eye burn. Chemical burns represent 7-10% of eye

injuries . About 15-20% of burns to the face involve at least oneeye. Although many burns result in only minor discomfort, every

chemical exposure or burn should be taken seriously. Permanent

damage is possible and can be blinding and life-altering.

The severity of a burn depends on what substance caused it, how

long the substance had contact with the eye, and how the injury is

treated. Damage is usually limited to the front segment of the eye,

including the cornea, the conjunctivaand occasionally the internal

eye structures of the eye, including the lens. Burns that penetrate

deeper than the cornea are the most severe, oftencausing cataracts and glaucoma NOTE:

Alkali burn more sever than acid burn bcz

it penetrate through the tissue to inside

bcz it diffuse more rapidly than acis so it

has worst prognosis

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Chemical burns to the eye can be divided into three categories:

Alkali burns are the most dangerous. penetrate the surface of the eye and can cause

severe injury to both the external structures and the internal structures. In general,

more damage occurs with higher pH chemicals.

Common alkali substances contain the hydroxides ofammonia,

lye, potassium hydroxide,, magnesium, and lime.

Acid burns: are usually less severe than alkali burns because they do not penetrate into

the eye as readily as alkaline substances. The exception is a hydrofluoric acid burn,

which is as dangerous as an alkali burn. Acids usually damage only the very front of the

eye; however, they can cause serious damage to the cornea and also may result

in blindness.

Common acids causing eye burns include sulfuric acid, sulfurous acid, hydrochloric acid,

nitric acid, acetic acid, chromic acid, and hydrofluoric acid.

Irritants are substances that have a neutral pH and tend to cause more discomfort to the

eye than actual damage.

http://www.emedicinehealth.com/script/main/art.asp?articlekey=25654http://www.emedicinehealth.com/script/main/art.asp?articlekey=9970http://www.emedicinehealth.com/script/main/art.asp?articlekey=4243http://www.emedicinehealth.com/script/main/art.asp?articlekey=20629http://www.emedicinehealth.com/script/main/art.asp?ArticleKey=101819http://www.emedicinehealth.com/script/main/art.asp?ArticleKey=101819http://www.emedicinehealth.com/script/main/art.asp?articlekey=20629http://www.emedicinehealth.com/script/main/art.asp?articlekey=4243http://www.emedicinehealth.com/script/main/art.asp?articlekey=9970http://www.emedicinehealth.com/script/main/art.asp?articlekey=25654

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Early signs and symptoms of a chemical eye burn are:

1. Pain

2. Redness

3. Irritation

4. Tearing

5. Inability to keep the eye open

6. Sensation of something in the eye

7. Swelling of the eyelids

8. Blurred vision

Sign and symptoms

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Treatment :

Treatment should be instituted immediately, even before testing vision.

Emergency treatment:

1-copious irrigation of the eyes, preferably with saline or ringer lactate.

Dont use acidic solutions to neutralize alkalis or vice versa.

Pull down the lower eyelid and evert the upper eyelid to irrigate the

fornices

2-irrigation should be continued until neutral PH is reached.

The volume of irrigation fluid required to reach neutral PH varies with

the chemical and the duration of the chemical exposure

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Treatment cont..For mild to moderate burns (during and after irrigation):

cycloplegic

topical antibiotic

oral pain medication

if increase IOP use drugs to reduce it (acetazolamide,

methazolamide add b blocker if additional IOP control is

required)

frequent use of preservative free artificial tear

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Tratment contFor severe burns (Treatment after irrigation): Admission to the hospital Lysis of conjunctival adhesion

Debride necrotic tissue

Topical antibiotic

Topical steroid

Consider a pressure patch Antiglaucoma medication if the IOP is increased or cant be

determined

Frequent use of preservative free artificial tear

Other consideration:

Therapeutic contact lenses, collagen, amniotic membrane transplantIV ascorbate and citrate for alkali burns

If any melting of the cornea occurs, collagenase inhibitors may beused

If the melting progresses an emergency patch graft or corneal

transplat may be necessary.

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Chemical burn (injury)A hazy cornea following an alkali burn

h i h h l i i

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Sympathetic ophthalmitisDefinition :

An autoimmune eye disease in which a penetrating injury to one eye produces inflammation in

the uninjured eye. (The injured eye is termed the "exciting" eye while the uninjured one is the

"sympathetic" eye.)

pathophysiology: the original eye injury always involves the uvea, specifically the ciliary body, releasing

uveal pigment into the bloodstream. This triggers the formation of antibodies which cause

inflammation of the uvea (uveitis) in the uninjured eye with gradually progressive loss of

vision. The symptoms are blurry vision and pain in both eyes

Diagnosisis clinical, seeking a history of eye injury. An important differential diagnosis is Vogt-

Koyanagi-Harada syndrome (VKH), which is thought to have the same pathogenesis,

without a history of surgery or penetrating eye injury.

Surgical eye removal - to remove one to hopefully save the second from autoimmune infection.Read more at http://www wrongdiagnosis com/s/sympathetic ophthalmitis/treatments htm?ktrack=kcplink

Surgical eye removal - to remove one to hopefully save the second from autoimmune infection.Read more at http://www wrongdiagnosis com/s/sympathetic ophthalmitis/treatments htm?ktrack=kcplink

Surgical eye removal - to remove one to hopefully save the second from autoimmune infection.Read more at http://www wrongdiagnosis com/s/sympathetic ophthalmitis/treatments htm?ktrack=kcplink

http://en.wikipedia.org/wiki/Vogt-Koyanagi-Harada_syndromehttp://en.wikipedia.org/wiki/Vogt-Koyanagi-Harada_syndromehttp://en.wikipedia.org/wiki/Vogt-Koyanagi-Harada_syndromehttp://en.wikipedia.org/wiki/Vogt-Koyanagi-Harada_syndromehttp://en.wikipedia.org/wiki/Vogt-Koyanagi-Harada_syndromehttp://en.wikipedia.org/wiki/Vogt-Koyanagi-Harada_syndromehttp://en.wikipedia.org/wiki/Vogt-Koyanagi-Harada_syndrome

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Read more athttp://www.wrongdiagnosis.com/s/sympathetic_ophthalmitis/treatments.htm?ktrack kcplinkRead more athttp://www.wrongdiagnosis.com/s/sympathetic_ophthalmitis/treatments.htm?ktrack kcplinkRead more athttp://www.wrongdiagnosis.com/s/sympathetic_ophthalmitis/treatments.htm?ktrack kcplink

Treatment :Corticosteroids

Immunosuppressant

Surgical eye removal - to remove one to hopefully save the second from

autoimmune infection.

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