Caring for patients with eye injuries, neoplastic growth of the eye. Lecturer: Lilya Ostrovska

Ocular Trauma

Nature of Injury  Blunt  Lacerating  Chemical

Blunt Trauma  Mild – moderate  “bruise” ocular tissues  Eye wall intact  Moderate – severe  Rupture eye wall  Very severe consequences

Lacerating Trauma  “cut” eye wall  Outcome depends on extent and location

Location of Injury  Anterior Segment  Posterior Segment  Adnexa  Orbital Structures

Anterior Segment  Conjunctiva  Cornea  Iris  Lens

Posterior Segment  Vitreous  Retina  Optic nerve

Adnexa  Eyelids  Lacrimal Structures

Orbital Structures  Extraocular muscles  Bony walls

Disgusting Photographs  Front to back…

Racoon Eye

Lid Laceration

Subconjunctival Hemorrhage

Corneal Foreign Body

Corneal Abrasion

Curling Iron Burn

Corneal Laceration

Iris Sphincter Rupture

Hyphema

Traumatic Cataract

Vitreous Hemorrhage

Retinal Hemorrhage

Optic Disc Hemorrhage

Orbital Wall Fracture

Common Minor Eye Injuries  Corneal abrasion  Corneal foreign body  Chemical splash  Traumatic iritis

Diagnosis  History  Sharp vs blunt vs chemical injury  Exam  CHECK VISION

Diagnosis cont.  Exam – Pry lids apart!  Cornea clear?  Pupil round?  Pupil black?  Blood clotted behind cornea?

Diagnosis cont.  Exam  Red reflex?  Eyes move symmetrically?

Fluorescein Test  Topical “eye dye”  COBALT light

Corneal Abrasion

Abrasion Treatment  Erythromycin ointment  +/- patch  1-2 day follow-up with eye doc

Corneal Foreign Body

Foreign Body Treatment  Anesthetize eye  Remove FB  Cotton swab (don’t worsen abrasion!)  Kimura spatula  +/- needle tip  E-mycin and +/- patch  1-2 day follow-up with eye doc

Chemical Splash

Chemical Treatment  IRRIGATE  Check pH  Minor  E-mycin ointment  1 day follow-up eye doc  Major  Same day eval by eye doc

Traumatic Iritis  Moderate blunt injury  Photophobia  Lid bruising/edema  Subconj heme or injection  Pupil sluggish  Eval by eye doc

Please Do Not Confuse  Subconjunctival hemorrhage  Hyphema

OCULAR ONCOLOGY

OSSN  Ocular surface squamous neoplasia  Encompasses conjunctival/corneal intraepithelial neoplasia (CIN)  Squamous conjunctival dysplasia  Carcinoma in situ  Invasive squamous cell carcinoma (SCC)

Squamous cell carcinoma Extensive Ill defined edges Vascularised Corneal involvement

Conjunctival melanoma  Primary aquired conjunctival melanosis (PAM)  Preexisting conjunctival naevus  De novo

PAM Biopsy if: Growth Nodule formation Vascularity  Primary acquired conjunctival melanosis

De novo conjunctival melanoma

Rx Conjunctival SCC / Melanoma  Excision / cryotherapy to cut conjunctival margin  Topical Mitomycin C  Episcleral plaque radiotherapy if recurrence

Iris melanoma

Congenital hypertrophy of the retinal pigment epithelium (CHRPE)

Choroidal neovascularisation: high myopia (Fuch’s spot)

Choroidal haemangioma

Melanocytic tumours of the posterior uvea  Naevus  Melanoma

Drusen Fibrous metaplasia of RPE Choroidal naevus

Uveal melanoma treatment  Observation Tumours < 2mm thick

Symptoms Thickness > 2mm Orange pigment (lipofuscin) Growth Subretinal fluid Peripapillary location

Uveal melanoma treatment Observation  Transpupillary laser thermotherapy (TTT)

Uveal melanoma treatment  Observation  TTT  Local resection Anterior to equator Base < 10mm

Uveal melanoma treatment  Observation  TTT  Local resection  Radioactive plaque therapy Thickness < 8mm Base <15mm

Ruthenium 106 Iodine 125

Uveal melanoma treatment  Observation  TTT  Local resection  Radioactive plaque therapy  Proton beam/helium ion irradiation  Gamma knife therapy

Uveal melanoma treatment  Observation  TTT  Local resection  Radioactive plaque therapy  Proton beam/helium ion irradiation  Gamma knife therapy  Enucleation Base > 15mm

Metastatic tumours  Breast / lung carcinoma  Amelanotic  Multifocal  Choroidal  Treat only if sight affected

Amelanotic Multifocal Choroidal Posterior to equator

THANKS FOR YOUR ATTENTION !