Caring for patients with eye injuries, neoplastic growth of the eye.

Lecturer: Lilya Ostrovska

Ocular Trauma

Nature of InjuryBluntLaceratingChemical

Blunt TraumaMild moderatebruise ocular tissuesEye wall intactModerate severeRupture eye wallVery severe consequences

Lacerating Traumacut eye wallOutcome depends on extent and location

Location of InjuryAnterior SegmentPosterior SegmentAdnexaOrbital Structures

Anterior SegmentConjunctivaCorneaIrisLens

Posterior SegmentVitreousRetinaOptic nerve

AdnexaEyelidsLacrimal Structures

Orbital StructuresExtraocular musclesBony walls

Disgusting PhotographsFront to back

Racoon Eye

Lid Laceration

Subconjunctival Hemorrhage

Corneal Foreign Body

Corneal Abrasion

Curling Iron Burn

Corneal Laceration

Iris Sphincter Rupture

Hyphema

Traumatic Cataract

Vitreous Hemorrhage

Retinal Hemorrhage

Optic Disc Hemorrhage

Orbital Wall Fracture

Common Minor Eye InjuriesCorneal abrasionCorneal foreign bodyChemical splashTraumatic iritis

DiagnosisHistorySharp vs blunt vs chemical injuryExamCHECK VISIONCHECK VISIONCHECK VISION

Diagnosis cont.Exam Pry lids apart!Cornea clear?Pupil round?Pupil black?Blood clotted behind cornea?

Diagnosis cont.ExamRed reflex?Eyes move symmetrically?

Fluorescein TestTopical eye dyeCOBALT light

Corneal Abrasion

Abrasion TreatmentErythromycin ointment+/- patch1-2 day follow-up with eye doc

Corneal Foreign Body

Foreign Body TreatmentAnesthetize eyeRemove FBCotton swab (dont worsen abrasion!)Kimura spatula+/- needle tipE-mycin and +/- patch1-2 day follow-up with eye doc

Chemical Splash

Chemical TreatmentIRRIGATECheck pHMinorE-mycin ointment1 day follow-up eye docMajorSame day eval by eye doc

Traumatic IritisModerate blunt injuryPhotophobiaLid bruising/edemaSubconj heme or injectionPupil sluggishEval by eye doc

Please Do Not ConfuseSubconjunctival hemorrhageHyphema

OCULAR ONCOLOGY

OSSNOcular surface squamous neoplasiaEncompasses conjunctival/corneal intraepithelial neoplasia (CIN)

Squamous conjunctival dysplasiaCarcinoma in situInvasive squamous cell carcinoma (SCC)

Squamous cell carcinomaExtensiveIll defined edgesVascularisedCorneal involvement

Conjunctival melanomaPrimary aquired conjunctival melanosis (PAM)Preexisting conjunctival naevusDe novo

PAMBiopsy if:GrowthNodule formationVascularityPrimary acquired conjunctival melanosis

De novo conjunctival melanoma

Rx Conjunctival SCC / MelanomaExcision / cryotherapy to cut conjunctival marginTopical Mitomycin CEpiscleral plaque radiotherapy if recurrence

Iris melanoma

Congenital hypertrophy of the retinal pigment epithelium (CHRPE)

Choroidal neovascularisation: high myopia (Fuchs spot)

Choroidal haemangioma

Melanocytic tumours of the posterior uveaNaevusMelanoma

DrusenFibrous metaplasia of RPEChoroidal naevus

Uveal melanoma treatmentObservationTumours < 2mm thick

SymptomsThickness > 2mmOrange pigment (lipofuscin)GrowthSubretinal fluidPeripapillary location

Uveal melanoma treatmentObservationTranspupillary laser thermotherapy (TTT)

Uveal melanoma treatmentObservationTTTLocal resection

Anterior to equatorBase < 10mm

Uveal melanoma treatmentObservationTTTLocal resectionRadioactive plaque therapyThickness < 8mmBase

Ruthenium 106Iodine 125

Uveal melanoma treatmentObservationTTTLocal resectionRadioactive plaque therapyProton beam/helium ion irradiationGamma knife therapy

Uveal melanoma treatmentObservationTTTLocal resectionRadioactive plaque therapyProton beam/helium ion irradiationGamma knife therapyEnucleationBase > 15mm

Metastatic tumoursBreast / lung carcinoma

AmelanoticMultifocalChoroidal

Treat only if sight affected

AmelanoticMultifocalChoroidalPosterior to equator

THANKS FOR YOUR ATTENTION !

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