OCULAR INJURIES- An introduction & nomenclature Ayesha S Abdullah

Learning outcomes By the end of this lecture the students would be able to  Describe the epidemiology of ocular injuries  Classify globe injuries according to the Birmingham Eye Trauma Terminology (BETT) system of classification  Differentiate between OGI and CGI

How common is it?  Trauma is the commonest cause of ocular emergencies reported in trauma centres  A total of 1.6 million cases of blindness are caused by eye injures  Some 2.3 million cases with low vision are due to ocular injuries  Some 19 million cases of mono ocular blindness are due to eye injuries

Risk factors  Gender, any guess?  3:1 male to female ratio  Rural areas  Compromised socioeconomic status  Illiteracy  Conflicts

Classification  According to vector (The Agent)  According to settings (Place of injury)  According to pathology (Effects produced)  According to anatomical structures involved  According to severity (Damage produced)

According to the site involved  Orbital trauma  Superficial & corneal foreign bodies  Lid injuries  Globe injuries

Nature of injurious agent  Mechanical Injuries  Chemical Injuries Acid Alkali Others  Radiation Injuries  Thermal Injuries  Electrical Injuries

Place of Injury  Home  School  Playground  Agriculture  Industry  Laboratory  Workshops  Assault/ combat

Birmingham Eye Trauma Terminology System (BETTS)

Definitions -BETTS  Closed Injury in which cornea & sclera are intact but there is intraocular damage.  Open Injury is associated with full-thickness wound of cornea or sclera or both.  Rupture is a full-thickness wound caused by blunt trauma  Laceration is full-thickness injury caused by a sharp object  Penetration is caused by a single laceration with a sharp object  Perforation consists of two lacerations, one entry and one exit

Orbital trauma  Blow out floor fracture, medial wall, floor, roof  Contusion injury  Lacerations  Orbital haematoma

Eye Lids  Contusion  Hematoma  Lacerations

Beware of the blood loss especially in children

Late Complications

Effects of close globe injury (CGI)  Mechanism  AP compression  Expansion in the equatorial plan  Transient & excessive increase in IOP  Impact is primarily absorbed by ?? Lens –Iris diaphragm & vitreous  The damage can happen in any tissue  commonly has long-term effects/ sequelae

Close Globe Injuries  Subconjunctival Haemorrhage  Corneal abrasion  Acute corneal oedema  Traumatic iritis  Traumatic Mydriasis / Miosis  Hyphaema  Iridodialysis  Cyclodialysis / Angle recession  Ciliary shock

Close Globe Injuries  Subluxation and dislocation of lens  Cataract  Posterior vitreous detachemet  Vitreous haemorrhage  Choroidal rupture  Commotio retinae  Retinal Breaks Dialysis Equatorial tears Macular holes  Optic nerve avulsion

Home work List three recommendations for the following  Primary  Secondary  Tertiary prevention of ocular trauma Three power point slides with three points on each slide send at with your name and role number