Ocular trauma

Outline ocular trauma Ⅰ. mechanical factors Ⅱ. physical factors Ⅲ. chemical factors

Classification Causative factors of injury –Mechanical ocular trauma –Non-mechanical ocular trauma Degree of injury –Microtrauma –Moderate injury –Macrotrauma

Outline New classification Ocular trauma CloseOpen Contusion Laminar laceration Rupture Penetration Foreign body Penetration-through Laceration

Examination Examination of ocular trauma –History –General condition –Visual acuity –Extra-eye examination –eyeball examination –Assist examination

Treatment –to rescue life –chemical injury —— to rinse with mass of water –Open injury—— TAT –Penetration injury—— to avoid pressure –Reasonable antibiotics

Ocular contusion Ocular contusion ： caused by mechanical blunt force > 1/3 ocular trauma Causative factors of injury –Blunt body –High-pressure gas ／ fluid –Blunt force conduction —— indirect injury

Ocular contusion § Corneal Bruise § Iris and Ciliary Body Bruise Iris injury and pupil abnormity Iris injury and pupil abnormity Hyphema § Lens Bruise § Vitreous hemorrhage § Choroid Bruise § Retinal Commotion and Bruise

Corneal Bruise Clinical manifestation and treatment –Superficial lamella abrasion —— antibiotic ointment ＋ eyepatch and to avoid topical anaesthesia –Corneal stroma injury—— glucocorticoid ， mydriasis when necessary –Corneal rupture —— suture

Corneal Bruise

Iris and Ciliary Body Bruise TraumaTrauma iridocyclitis Clinical manifestationClinical manifestation ， –diminution of vision ， irritation –ciliary congestion –Iris edema, –Iris edema, blurred texture –Tyndall’s sign –KP TreatmentTreatment ／ –Glucocorticoid ／ NSAID –Mydriatic

Iris and Ciliary Body Bruise

Iris injury and pupil abnormity

Iris and Ciliary Body Bruise clinical manifestation Hyphema

Iris and Ciliary Body Bruise Hyphema Treatment –Semi-reclining position and resting –Double eyepatch –No Myosis nor Mydriasis –Cold pack first and then hot pack –Sedation –Hemostatic drug –Operation —— high IOP

Lens Bruise Change of lens transparence —— Traumatic cataract Treatment Operation

Lens Bruise Change of lens position Treatment –Operation

Vitreous hemorrhage

Treatment –A little —— Self-absorption –No absorption more than 3 months —— Vitrectomy –Retinal detachment —— Operation

Choroid Bruise Treatment No special treatment

Retinal Commotion and Bruise

Ocular rupture Clinical manifestation –IOP –Hyphema /vitreous hemorrhage –Subconjunctival hemorrhage or hematom –Corneal deformation –Limitation of eyeball movement –VA —— no LP Treatment –Exploration –treatment

Ocular Penetration

Complications –Traumatic iridocyclitis –Intraocular foreign body –Infectivity endophthalmitis –Sympathetic ophthalmia –Traumatic PVR

Ocular Penetration Basic principle –To Rehabilitate wound in time and recover ocular integrity –To prevent and treat infection and other complications Operation ： primary or secondary antibiotics ： local ／ general Atropine Glucocorticoid ／ NSAID ： local ／ general

Ocular Penetration

Foreign Body

Extraocular Foreign Body

Intraocular Foreign Body

Treatment principle –Diagnosis in time and operation at the right moment in order to keep and recover vision

Ocular Appendix Trauma

Eyelid Trauma

Orbital Trauma

Chemical Burn

Base burn –Tissue lysis ， easy pervasion and severe –Blurred circumscription ， progressive –corneal epithelium exfoliation ： usual –blood vessel invasion ： obvious –necrosis ： pervasion to deep –Intraocular damage ： yes Acid burn –coagulation necrosis ， reduce pervasion ， not severe relatively –Clear circumscription ， no progressive –corneal epithelium exfoliation ： occasional –blood vessel invasion ： no obvious –necrosis ： limit to contact surface –Intraocular damage ： little

Chemical Burn

First aid ： to rescue in time –To disengage chemical contact immediately and rinse in locale as soon as possible ： mass of water ， long time –Neutralization ： acid —— 2 ％ Sodium bicarbonate, sulfadiazine base —— Vitamin C Infection prevention ： antibiotic To promote healing ： epidermal growth factor ， Vitamin C prevention and cure symblepharon and other complication –mydriasis : Atropine –glucocorticoid –Collagenase inhibitor –Tear Substitute ／ contact lens Complication Treatment ： Operation

THANK YOU!