OCULAR TRAUMA Contusions (concussions) Contusions (concussions) Penetrating injuries Penetrating injuries Burns Burns

Blunt Injuries A) Of the external structure of the eyeball Eyelids Ecchymosis Ecchymosis Excoriations Excoriations Lacerations Lacerations Profound or superficial wounds Profound or superficial wounds

Orbit Contusion- appear during the cranio-facial contusions Contusion- appear during the cranio-facial contusions  Fractures of the orbital walls  Fractures of the optic canal (lesions of the optic nerve)  Orbital haematoma  Orbital emphysema

Conjuctiva Subconjunctival hemorrhages Subconjunctival hemorrhages  Unilateral  Absorbing normally within 7-10 days  Bilateral  Appear 1-2 days after the trauma= fracture of the cranial base Foreign bodies Foreign bodies Lacrimal system Luxation of the lacrimal gland Luxation of the lacrimal gland

Subconjunctival hemorrhages

B) Of the eyeball Sclera Scleral rupture- in zones of minimal resistance (the equator, the area next to corneoscleral limbus) Scleral rupture- in zones of minimal resistance (the equator, the area next to corneoscleral limbus)  Subconjunctival luxation of the lens  Eye atrophy  Uveitis  Treatment: lens extirpation, suture of the rupture

Traumatic syndrome of the anterior segment Cornea Erosions or abrasions Erosions or abrasions Profound keratitis with edema and cellular infiltration of the stroma Profound keratitis with edema and cellular infiltration of the stroma Folds of the Descemetic membrane Folds of the Descemetic membrane Anterior chamber bleeding> hyphema bleeding> hyphemaIris Radial ruptures of the pupilary margins Radial ruptures of the pupilary margins Iridodialisis (detachment of the iris root from the ciliary body) Iridodialisis (detachment of the iris root from the ciliary body)

Hyphema Hyphema Iris rupture Iris rupture

Lens Subluxation Subluxation Luxation in the AC or vitreous Luxation in the AC or vitreous Cataract (concussion cataract) Cataract (concussion cataract) Ocular fundus Choroidal rupture- in the macula Choroidal rupture- in the macula Retinal edema +/- hemorrhages Retinal edema +/- hemorrhages Retinal tears Retinal tears Retinal detachment (myopia, aphakic) Retinal detachment (myopia, aphakic)

Subluxated opacified lens

Penetrating injuries A) Of the external eye structures Eyelids- eyelids wounds> needs surgery Orbit- wounds may involve  The optic nerve  Extrinsec muscles  Orbital vessels  Foreign bodies Conjunctiva- wounds

B) Of the eyeball Cornea Wounds are penetrating, with lens/ iris prolapse Wounds are penetrating, with lens/ iris prolapse The pupil is distorted in shape The pupil is distorted in shapeSclera Wounds> ocular hypotony, incarceration of the uvea, +/- foreign bodies Wounds> ocular hypotony, incarceration of the uvea, +/- foreign bodies

Penetrating corneal wound (iris blocking the small corneal wound)

Complications Complications  Exogenous septical uveitis  Panendophthalmitis  Retain of the foreign body Treatment Treatment  Surgery +/- extraction of intraocular foreign body

BurnsEthiology Physical Physical  Light (flame, electric current)  UV radiation (phototraumatism) Chemical Chemical  Acid/ alkaline substances

Clinical features- degree of burn Grade I Hyperemia of both eyelid skin + conjunctiva Hyperemia of both eyelid skin + conjunctiva Cornea: erosions Cornea: erosions Evolution: healing without sequelae Evolution: healing without sequelae Grade II Phlyctenules of the eyelid skin Phlyctenules of the eyelid skin Conjunctiva: erosions, edema Conjunctiva: erosions, edema Cornea: abrasion, ulceration; cloudy cornea Cornea: abrasion, ulceration; cloudy cornea Exogenous toxic uveitis Exogenous toxic uveitis

Alkali corneal burn Grade III acid burn at presentation (a) and after 3 months (b) Grade III acid burn at presentation (a) and after 3 months (b)

Grade III Eyelids: profound necrotic lesions Eyelids: profound necrotic lesions Conjunctiva: pale/ necrosis Conjunctiva: pale/ necrosis Sclera: necrotic damages Sclera: necrotic damages Exogenous uveitis Exogenous uveitis Evolution: Evolution:  Cicatricial eyelid retraction> ectropion  Adherent scars> symblepharon  Vascularised corneal leucoma> very low VA

Pathogenesis: Acid- coagulation of tissue proteins Acid- coagulation of tissue proteins Alkaline- liquefaction of the tissue albumin Alkaline- liquefaction of the tissue albuminTreatment: Large- local irrigation with water Large- local irrigation with water Atropine/ mydriatic drops Atropine/ mydriatic drops Lubricant ointments Lubricant ointments Surgery for complications Surgery for complications