Armando Hasudungan
Biology and Medicine videos

Eye Trauma

  Remember Wounds require tetanus prophylaxis and broad spectrum antibiotic if significant risk of contamination, or debridement of necrotic tissue. History Likely foreign body Which eye Mechanism Velocity Protective eye wear? Previous eye trauma – reduced structural integrity When did it happen? Contact lens wearer What are the symptoms? Photophobia Discharge and type Side note Small […]

 

Remember Wounds require tetanus prophylaxis and broad spectrum antibiotic if significant risk of contamination, or debridement of necrotic tissue.

History

  • Likely foreign body
  • Which eye
  • Mechanism
    • Velocity
  • Protective eye wear?
  • Previous eye trauma – reduced structural integrity
  • When did it happen?
  • Contact lens wearer
  • What are the symptoms?
    • Photophobia
    • Discharge and type
Side note Small projectiles at high velocities increase the likelihood of penetrating trauma. Symptoms include loss of vision, pain on movement and diplopia

 

Features requiring urgent referral
Contact lens wearer
Previous eye surgery or refractive surgery
Decreased vision
Severe pain
Nausea and vomiting
Cloudy or opaque cornea
Dendritic ulcer
Hypopyon (pus in the anterior chamber)
Nonreactive pupils or RAPD
Ocular trauma
Persisting or worsening symptoms
Chemical to eye

Blunt trauma

  • Types
    • Closed globe injury
    • Ruptured globe
  • Signs
    • Haemorrhage
      • Hyphaema
      • Vitreous
      • Retina → retinal detachment
    • Vision changes
      • Iris damage
      • Lens damaged or dislocated
      • Angle of eye drainage damage
  • Investigate: CT scan for orbital wall fracture
  • Management: Topical antibiotics and suture eye lid lacerations and urgent referral
Signs of an inferior blowout fracture
Ecchymosis/oedema
Diplopia
A recessed eye
Defective eye movement
Ipsilateral nose bleed
Diminished sensation over the distribution of the infraorbital nerve

Penetrating trauma

  • Prolapse of the intraocular contents and irreversible damage can occur
  • Signs:
    • Distorted pupil
    • Cataract
    • Prolapsed black uveal tissue on the ocular surface
    • Vitreous haemorrhage
  • Dilate pupil and search for intraocular foreign body
    • Radiograph with eye in up and down gaze
    • Apply shield and transfer to eye department
  • All penetrating eye injuries need immediate referral
  • Management:
    • Nil by mouth
    • Strict bed rest
    • Analgesia/antiemetic
    • CT
    • Shield (not pad)
    • Tetanus status
    • Broad spectrum antibiotics

Corneal foreign body

  • Any foreign body penetration of the cornea or retained foreign body will require urgent referral to ophthalmologist – immediate consult by phone
  • Management removing corneal foreign body
    • Topical anaesthetic
    • Slit lamp and remove body
      • Cotton bud
      • Fine needle
      • Motorised dental burr
    • Use fluorescein to assess and measure the size of epithelial defect
    • Topical antibiotics and cycloplegic agent
    • Refer to ophthalmologist if body not removed and symptoms worsen

Chemical Burns Management

  • Instil local anaesthetic drops to affected eye/eyes.
  • Commence irrigation with 1 litre of a neutral solution, eg N/Saline (0.9%), Hartmann’s.
  • Evert the eyelid and clear the eye of any debris / foreign body that may be present by sweeping the conjunctival fornices with a moistened cotton bud.
  • Continue to irrigate, aiming for a continuous irrigation with giving set regulator fully open.
    • If using a Morgan Lens, carefully insert the device now.
  • Review the patient’s pain level every 10 minutes and instil another drop of local anaesthetic as required.
  • After one litre of irrigation, review.
    • If using a Morgan Lens, remove the device prior to review.
  • Wait 5 minutes after ceasing the irrigation luid then check pH. Acceptable pH range 6.5-8.5.
  • Consult with the senior medical oficer and recommence irrigation if necessary.
  • Severe burns will usually require continuous irrigation for at least 30 minutes
  • Immediate referral
Alkali Acidic
Lime Toilet cleaner
Mortor & plaster Car battery fluid
Drain cleaner Pool cleaner
Oven cleaner
Ammonia

 

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