Ocular Trauma.pptx

8/13/2019 Ocular Trauma.pptx

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Raisa Janet Ariestha ( I 111 09 041)Ocular Trauma


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Mechanical injuries:

Eyelid injuries.

Foreign body in the cornea and conjunctiva.

Nonpenetrating injury (blunt trauma to theglobe).

Penetrating injury (open-globe injury).

Chemical injuries.

Injuries due to physical agents:

Burns.

Radiation injuries (ionizing radiation).

Classification of Ocular Injuries

by Mechanism of Injury


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Etiology:- Eyelid lacerations with involvement of the

eyelid margin.

- Avulsions of the eyelid in the medial canthuswith avulsion of the lacrimal canaliculus. The highly vascularized and loosely textured

tissue of the eyelids causes them to bleedprofusely when injured

Hematoma and swelling will be severe Abrasions usually involve only the superficial

layers of the skin, whereas punctures, cuts,and all eyelid avulsions due to blunt trauma(such as a fist) frequently involve all layers.

Eyelid Injury

Mechanical Injuries


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Treatment: Surgicalrepair of eyelidinjuries, especially

lacerations withinvolvement of theeyelid margin, shouldbe performed with

care.

Eyelid Injury2

Mechanical Injuries


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Etiology: Airborne foreign bodies andmetal splinters from grinding or cutting disksin particular often become lodged in the

conjunctiva or cornea or burn their wayinto the tissue.

Symptoms and diagnostic considerations:

1. The patient experiences a foreign-bodysensation with every blink of the eye

2. Epiphora(tearing) and blepharospasm

Corneal and Conjunctival

Foreign Bodies

Mechanical Injuries


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Foreign Bodies

2

After a few hours or several days,

conjunctival or ciliary injection will bepresent.

Mechanical Injuries


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Treatment:

- Corneal and conjunctival foreign bodies.

The foreign body is pried out of its bed with a fine needle orcannula. Treated with an antibiotic eye ointment andbandaged if necessary.

- Subtarsal foreign bodies.Everting the upper and lower eyelids will usually reveal theforeign body, which may then be removed with a moistcotton swab. An antibiotic eye bandage is placed until thepatient is completely free of symptoms.


Foreign Bodies

3

Mechanical Injuries


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Etiology: From blunt trauma such as a fist,ball, champagne cork, stone, falling on theeye, or a cowshorn.

Deformation exerts significant traction onintraocular structures and can cause themto tear. Often there will be blood in theanterior chamber, which will initially

prevent the examiner from evaluating themore posterior intraocular structures.

Blunt Ocular Trauma (Ocular

Contusion)

Mechanical Injuries


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Blunt Ocular Trauma (Ocular

Contusion)

2

Mechanical Injuries


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Blunt Ocular Trauma (Ocular Contusion)3

Mechanical Injuries


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Etiology: Caused by sharp objects thatpenetrate the cornea and sclera.

Penetrating injuries cover the entire

spectrum of clinical syndromes. Symptomscan range from massive penetration of thecornea and sclera with loss of the anteriorchamber to tiny, nearly invisible injuries thatclose spontaneously.

Depending on the severity of the injury, thepatients visual acuity may be severelycompromised or not influenced at all.

Open-Globe Injuries

Mechanical Injuries

h i l j i


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Depending on the severity of the injury, thefollowing diagnostic signs will be present in anopen-globe injury:

- The anterior chamber will be shallow or absent- The pupil will be displaced toward thepenetration site

- Swelling of the lens will be present (traumaticcataract)

- There will be bleeding in the anterior chamberand vitreous body

- Hypotonia of the globe will be present.

Open-Globe Injuries2

Mechanical Injuries

M h i l I j i


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Treatment:1. First aid

- Where penetrating trauma is suspected, a sterile bandage shouldbe applied and the patient referred to an eye clinic for treatment.

- Tetanus immunization or prophylaxis and prophylactic antibiotictreatment are indicated as a matter of course.

2. Surgery

- Surgical treatment of penetrating injuries must include suturing theglobe and reconstructing the anterior chamber.

- Any extruded intraocular tissue, intraocular foreign bodies must beremoved.

Open-Globe Injuries3

Mechanical Injuries

Ch i l I j i


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Etiology: Can be caused by a variety ofsubstances such as acids, alkalis, detergents,solvents, adhesives, and irritants like tear gas.

Acid burns are less dangerous than alkaliburns. Acids cause immediate coagulationnecrosis in the superficial tissue.

Alkalis can penetrate by hydrolyzing structural

proteins and dissolving cells. This is referred toas liquefactive necrosis. They then causesevere intraocular damage by alkalizing theaqueous humor.

Chemical Injuries

Chemical Injuries

Ch i l I j i


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Symptoms:

- Epiphora, blepharospasm, and severe painare the primary symptoms

- Acid burns usually cause immediate loss ofvisual acuity due to the superficial necrosis.In alkali injuries, loss of visual acuity oftenmanifests itself only several days later.

Chemical Injuries2

Chemical Injuries

Ch i l I j i


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Chemical Injuries3

Chemical Injuries

Ch i l I j i


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Treatment: First aid- First aid at the scene of the accident

(coworkers or family members):1. Restrain blepharospasm by rigorously

holding the eyelids open.2. Irrigate the eye within seconds of the injury

using anywatery solution of neutral pH3. Carefully remove coarse particles from the

conjunctival sac4. Notify the rescue squad at the same time5. Transport the patient to the nearest

ophthalmologist or eye clinic.

Chemical Injuries4

Chemical Injuries

Chemical Injuries


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- Treatment by the ophthalmologist or at the eyeclinic:

1. Administer topical anesthesia to relieve painand neutralize blepharospasm.

2. With the upper and lower eyelids fully everted,carefully remove small particles such as residuallime from the superior and inferior conjunctivalfornices under a microscope using a moistcotton swab.

3. Flush the eye with a buffer solution. Long-term

irrigation using an irrigating contact lens may beindicated (the lens is connected to a cannula toirrigate the eye with a constant stream of liquid).

4. Initiate systemic pain therapy if indicated.

Chemical Injuries4

Chemical Injuries


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Injuries due to physical agents


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Treatment:

- Initial treatment consists of applying coolingantiseptic bandages to relieve pain, after

which necrotic areas of the skin, conjunctiva,and cornea are removed under localanesthesia.

- The affected areas are then treated with anantibiotic ointment.

Prognosis: The clinical course of a burn isusually less severe than that of a chemicalinjury. Usually they heal well when treated withantibiotic ointment.

Burns2




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Etiology: Ionizing radiation (neutron, or gamma/x-rayradiation) have high energy that can cause ionizationand formation of radicals in cellular tissue.

Symptoms and clinical picture:

- Loss of the eyelashes and eyelid pigmentationaccompanied by blepharitis are typical symptoms.

- A dry eye is a sign of damage to the conjunctivalepithelium (loss of the goblet cells).

- Loss of visual acuity due to a radiation cataract isusually observed within one or two years of irradiation.

- Radiation retinopathy in the form of ischemicretinopathy with bleeding, cotton-wool spots, vascularocclusion, and retinal neovascularization usuallyoccurs within months of irradiation.

Radiation Injuries (Ionizing

Radiation)




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Treatment and prophylaxis: Care should be takento cover the eyes prior to planned radiationtherapy in the head and neck. Radiation cataractmay be treated surgically. Radiation retinopathymay be treated with panretinal photocoagulationwith an argon laser.

Radiation Injuries (Ionizing

Radiation)



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Thankyou

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