Learning Outcomes By the end of this lecture the students would be able to  Diagnose OGI of the eye  Describe the complications of OGI  Describe the principles of management of OGI  Recommend measure for the primary, secondary and tertiary prevention of OGI

A 15 year old boy was hit in the eye with a cricket ball which of the following would the most likely complication a) Choroidal Tear b) Hyphaemia c) Macular Hole d) Optic Nerve Avulsion e) Scleral Rupture

A 30 year old lady presents with the complaint of splashing of some chemical into her right eye while cleaning the toilet, what would be the most appropriate first line of management  Ascertain the degree of limbal ischemia  Perform a vigilant examination  Refer to an ophthalmologist  Take a detailed history  Wash the eye with copious amount of water

OGI of the eye-Diagnosis  History  Clinical examination  Investigations

Management 1. Proceed with caution 2. Assess the total patient first: Make sure there is no life threatening injury and the patient is hemodynamically stable before proceeding with your exam. 3. Make the patient comfortable 4. Assess visual acuity and pupils 5. Assess the adenexal structures 6. Visualize the globe ………………………………………………………………… ……… AAO

Management 7. Evaluate the fellow eye 8. Use additional testing and imaging modalities 9. Refer for the repair 10. Talk with patient and family.

OGI with Intraocular Foreign Bodies (IOFB)  May damage the eye ○ Mechanically ○ Introducing infection ○ Causing severe inflammation ○ Toxic effects  Location of foreign bodies ○ Cornea ○ Anterior Chamber / Iris ○ Lens ○ Posterior Segment ○ Orbital

Types of foreign bodies  Inert Glass Stone Gold  Organic Plant Animal  Metallic Iron - Siderosis Copper- Chalcosis

OGI with I.O.F.B- Summary  Suspected in any ocular/orbital trauma.  Detailed Hx is important.  X-Rays(frontal/lateral)…..for presence  C.T…..for location.  MRI…..contraindicated(for metallic)  Electrophysiological test to assess integrity of optic nerve and retina  Infection (endophthalmitis/ panophthalmitis) Structural and functional damage and are the biggest threats

Siderosis bulbi

Sympathetic Ophthalmitis

Definition “Sympathetic Ophthalmitis is a very rare, bilateral,diffuse granulomatous panuveitis which occurs after penetrating ocular trauma, that is usually associated with uveal prolapse or rarely following intraocular surgery.”

Sympathetic Ophthalmitis  Trauma to Ciliary body and retina  Retinal S-antigen  Exciting eye (the injured eye)  Sympathizing eye ( the normal/uninjured eye)  Chronic granulomatpus inflammation  Sympathizing Eye also develops uveitis

Clinical presentation  Mostly (65-80% of the cases ) sympathetic uveitis develop between 2 weeks & 3 months after initial injury.  90% of all cases occur within the first year.  Anterior Segment: The Exciting eye -- evidence of initial trauma, excessively red & irritable, signs of granulomatous uveitis Sympathizing eye -- irritable, photophobia then bilateral granulomatous anterior uveitis with iris nodules & mutton fat KPs  Posterior Segment: Optic Disc swelling & multifocal choroiditis mostly the process becomes chronic & may be complicated by cataract, glaucoma & phthisis bulbi

Treatment  Topical & Systemic Steroids  Immunosuppressive therapy in steroid- resistant cases(Cyclosporin)  Enucleation of the injured eye, if performed within 7-10 days of the injury prevents sympathetic ophthalmitis. Enucleation of the exciting eye is of no benefit once the fellow eye becomes inflammed

Thermal Burns Usually caused by Flames Hot splashes Direct contact of hot metals Usually limited to the lids and the cornea Management Relive pain Prevent secondary infection of cornea from exposure Minimize Eye lid scarring Limited debridement Macular burn by solar eclipse

Ultra-violet Radiation Injury Caused by Welding arcs Snow blindness Involves cornea, very painful Heals within 24 hours Management Relive pain, cycloplegic agent, antibiotic eye drops / ointment Patch the eye

Test 1. Refractive errors 2. Strabismus 3. Amblyopia 4. Uveitis 5. Ocular injuries 15 MCQs+ 5 Marks for the HW assignment Total 20 marks