EYE TRAUMATHOLOGY EYE Pavel Stodůlka

HIGH RISK OF TRAUMA in today’s daily life Car accidents industry HIGH RISK OF TRAUMA in today’s daily life Car accidents industry

EYE TRAUMA CAUSES: 1. MECHANICAL 2. RADIATION 3. ELECTRICITY combined 4. HEAT 5. CHEMICAL

EYE TRAUMA CAUSES: 1. MECHANICAL 2. RADIATION 3. ELECTRICITY combined 4. HEAT 5. CHEMICAL

MECHANICAL 1. Structure - conj, cornea mechanism – foreign bodies - sharp x blunt - sharp x blunt 3. nonpenetrating x penetrating a) with foreign body a) with foreign body b) without foreign body b) without foreign body

CONJUNCTIVA & CORNEA 1. EROSION of cornea 2. RECURRENT EROSION 3. NONPENETRATING WOUNDS (ointment x suture) (ointment x suture) 4. PENETRATING WOUNDS (patching both eyes, suture) (patching both eyes, suture)

SCLERA 1. PENETRATION a) sclera only a) sclera only b) sclera & cornea b) sclera & cornea If corpus cilliaris also – severe bleeding If corpus cilliaris also – severe bleeding If extends more than 5mm behind limbus – retinal trauma If extends more than 5mm behind limbus – retinal trauma

FOREIGN BODIES

1. anamnesis (wind x hammer on chisel) 2. When foreign body suspected: CT CT

FOREIGN BODIES of CONJUNCTIVA & SCLERA FOREIGN BODIES of CONJUNCTIVA & SCLERA u feels just like erosion

u Superficial - wipe out by cotton tipped stick - turn over eyelid - turn over eyelid u deeply driven – dig out by needle - clean rusty remnants - clean rusty remnants - ATB ointment - ATB ointment Treatment: FOREIGN BODIES of CONJUNCTIVA & SCLERA FOREIGN BODIES of CONJUNCTIVA & SCLERA

w ANAMNESIS - metalosis - siderosis (Fe) - chalkosis (Cu) - chalkosis (Cu) blockage of enzymes in retinal rods & cones blockage of enzymes in retinal rods & cones regular follow ups with ERG regular follow ups with ERG w CT MATERIAL of FOREIGN BODIES MATERIAL of FOREIGN BODIES

u METAL - magnetic x nonmagnetic Fe 75% Fe 75% u NON METAL - inert x organic ( Fu, Cu & organic has to be removed ) MATERIAL of FOREIGN BODIES MATERIAL of FOREIGN BODIES

THERAPY u SUTURE - ASAP u REMOVAL of foreign body - forceps - magnet - magnet u VITRECTOMIY u ATB

DOUBLE PENETRATION Foreign body gets in the eye Foreign body gets in the eye and leaves it somewhere back. RISKS: endophtalmitis retinal detachment retinal detachment

MECHANICAL TRAUMA

u SOLID ORBITAL RIM u SOLID EYE WALL

CAN HIT ALL EYE STRUCTURES CAN HIT ALL EYE STRUCTURES MECHANICAL TRAUMA

EYE TRAUMA CAUSES: 1. MECHANICAL 2. RADIATION 3. ELECTRICITY combined 4. HEAT 5. CHEMICAL

BREAK ! BREAK ! Pavel Stodůlka, MD, PhD

EYE TRAUMA CAUSES: 1. MECHANICAL 2. RADIATION 3. ELECTRICITY combined 4. HEAT 5. CHEMICAL

Radiation trauma IR UV radioactive lasers solar

u glassblower cataract - history I R = heat

u ophtalmia fotoelectrica - welding - germicids - germicids - high mountains - high mountains u destroys corneal epithelial cels u pain 6 to 10 hours after (often come at night) u fluorescein dot like staining of cornea UV

u lubricating ointment UV Therapy:

u industrial accidents u terrorism u tumor therapy RADIOACTIVE

u the same as UV exposure, but milder u lens at risk too (delayed cataract) Radioactive Signs:

u lubricating ointment Radiactive Therapy:

u laser pointers u reflected laser beam (gogles) LASERS

u SOLAR RETINOPATHY u UV exposure – corneal epithelial defects SOLAR

EYE TRAUMA CAUSES: 1. MECHANICAL 2. RADIATION 3. ELECTRICITY combined 4. HEAT 5. CHEMICAL

u eye burns u cataract ELECTRICITY

EYE TRAUMA CAUSES: 1. MECHANICAL 2. RADIATION 3. ELECTRICITY combined 4. HEAT 5. CHEMICAL

u hot liquids u steam u molten metals HEAT

u temperature u time u volume HEAT

EYE TRAUMA CAUSES: 1. MECHANICAL 2. RADIATION 3. ELECTRICITY combined 4. HEAT 5. CHEMICAL

u ACIDS: coagulation & necrosis coagulation & necrosis u : ALKALINES colliquation & necrosis colliquation & necrosis CHEMICAL

most often and very dangerous: most often and very dangerous: unslaked LIME burn CHEMICAL BURN

water & water & water removal of chemical remnants chemical neutralization Chemical burn First aid:

prim. MUDr. Pavel Stodůlka, Ph.D.