Ocular Trauma

in Primary Care

Kenneth Chan

Connect 2016 - Wellington

Low velocity projectile -

superficial foreign body

Organic/metallic/synthetic

Removal under topical

anaesthesia

Central foreign body -

referral

History of minor trauma with

partial recovery but

recurrent discomfort

especially overnight

Needs debridement + patch

+ long-term lubricating

ointment

May need corneal ablative

laser

High index of suspicion when

history suggest high-velocity

projectile

Distortion of normal anatomy,

irregular pupil, iris prolapse

Change in visual acuity may

be minimal

Timely intervention usually

leads to good outcome

Severe blunt trauma to the

eye can cause scleral

rupture without obvious

external wound

Deflated eye with severe

loss of vision and loss of

intraocular content

Poor prognosis in spite of

prompt surgical treatment

Thorough examination for

intraocular foreign body is

necessary if entrance wound

is detected

Orbital imaging needed if

poor view of posterior

segment

Urgent surgical intervention

High risk of endophthalmitis

Thorough examination for

intraocular foreign body is

necessary if entrance wound

is detected

CT orbit needed if poor view

of posterior segment

Urgent surgical intervention

High risk of endophthalmitis

Orbital floor and medial

orbital wall blowout fracture

Manifest double vision and

reduction in extra ocular

movement, may be minimal

CT orbit recommended if

there is any suspicion of

orbital fracture

‘White-eye entrapment’

Delayed presentation

Impairment in elevation only

clinical sign in spite of

significant orbital floor

blowout

Immediate, copious

irrigation (>2L+ Saline)

until pH neutralises

Intensive topical and

systemic anti-inflammatory

treatment

Oral doxycycline and

vitamin C

Thank you