Eye Trauma

Notes

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