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 !