Ocular Injury Department of Ophthalmology Tianjin Medial University General Hospital Hua Yan, MD, PhD phuayan2000@163.com www.apots.org

General description The structure of the visual organ is very fine and weak Lose the ability to work Difficulties and sufferings in life Prompt and right management

Classification of ocular injury Mechanical ocular injury Contusion Laceration Rupture Non-mechanical ocular injury ocular chemical burns thermal burns radiation damage

Classification of mechanical ocular injury Closed injury Open injury Contusion Laceration Rupture Penetrating IFB Perforation Lamellar laceration

Mechanical injury of the eye Make up more than 80% of the total injuries metal fragment, instruments in work, knife, scissors, needle, pliers, shells, ears of wheat and grain, spots instruments, toys at home, explosive flying stone, iron piece, shell fragment in battlefield

Mechanical injury of the eye Take place young workers students youth people short of experience in work

Orbital Injury

Orbital injury - clinical findings Fracture of orbital wall and nearby cranial bone, nasal sinuses and optic canal (leading to optic nerve atrophy) Fracture of the ethmoid sinus (subcutaneous emphysema) Injuries of the eyelids, the globe and deep soft tissue of the orbit (orbital cellulitis) Intraorbital hemorrhage may induce exophthalmos and palpebral ecchymoma

Orbital injury - treatment Complications of nervous or systemic system - management Closed simple fracture of the orbital bony rim - no special treatment Severe injury of skull, reflex of the pupil should be examined Severe injury of soft tissue - debridement and suturing layer, TAT and antibiotic Large foreign body in the orbit should be extracted as early as possible Small and deep ones, generally extractive operation isn’t needed. Intraobital hemorrhage - pressure bandage

Palpebral injury

Palpebral injury - clinical findings Palpebral skin is thin and loose, it is quite easy to be healed after injury and the infection is rare Palpebral swelling and hemorrhage Subconjunctival hemorrhage may spread into the subcutaneous tissue of another eye through the nose bridge Breakdown of the palpebral margin Breaking of ligaments of the inner and outer canthi

Palpebral injury - treatment The palpebral edema and hemorrhage may be absorbed spontaneously Fresh wound must be debridement and sutured as early as possible Tetanus antitoxin (TAT) Antibiotic

Conjunctival foreign body - clinical findings Dust, coal dust and small insect Most of the foreign bodies are pushed into the inferior tarsal sulcus of the upper eyelid Foreign body sensation, pain, tearing, and palpebral spasm Conjunctival hyperemia Eyelid is everted, fine foreign body often lodges in the lower tarsal sulcus of the conjunctiva in the upper eyelid

Conjunctival foreign body - treatment Removed by wet cotton roll or clean towel

Corneal foreign body

Corneal foreign body - etiology Metal pieces Dust in atmosphere Insects Husks Explosive injury

Corneal foreign body - clinical findings Foreign body sensation Pain Photophobia Tearing Palpebral spasm

Corneal foreign body - treatment Don’t rub the eye Remove with cotton-tipped applicator after surface anesthesia with 0.5%-1% dicaine solution After several hours of existing, an iron pieces arouses siderosis on its surrounding tissue Rust is difficult to be removed clearly

Penetrating injury of the globe

Penetrating injury of the globe Beat something with a hammer, splashing pieces to eye The severity of penetrating injury is related to many factors Size Shape Character of instruments causing trauma Splashing velocity Injured site Polluted degree

Penetrating injury of the globe – clinical findings Direct damage to ocular tissue Corneal penetrating injury Prolapse of intraocular contents Secondary glaucoma Traumatic cataract Intraocular hemorrhage

Severity of penetrating injury Endophthalmitis---Intraocular infection Intraocular foreign body Inflammatory reaction Metal foreign body may harm intraocular tissue Sympathetic ophthalmia Sometimes penetrating injury or intraocular foreign body in one eye leads to severe uveitis in another eye which is called sympathetic ophthalmia

Penetrating injury of the globe - treatment Don’t squeeze injured eye on examination Emergency treatment clean the wound instill antibiotic ointment and bandage both eyes transmit the wounded to hospital in time tetanus antitoxin Corneal, scleral wound should be sutured as early as possible As for corneal or scleral wound with prolapse of the uvea, if it is within 24 hours, the wound is clean, the prolapsed tissue may be replaced into the eye

Penetrating injury of the globe - treatment In order to prevent iris incarceration, injection of air into the anterior chamber should be done For the corneal line wound which is less than 3mm with no incarceration, the anterior chamber is restored all or partially, suture isn’t needed Minor and closed scleral wound needn’t be sutured Inject antibody into subconjunctiva Examination next day

Intraocular foreign body

Intraocular foreign body Commonly occurred in eye injury Steel, iron, copper, non – metal foreign body In the anterior chamber, lens, vitreous, incarcerated in the retinal and uvea Stable substance such as gold, silver, glass, stone and etc may lead to simple exudative reaction surrounding the foreign body Steel and iron within the eye bring about severe reaction

Intraocular foreign body - diagnosis Injury history Signs Ocular examination X ray CT

Preoperative examinations Visual acuity Slit lamp examination Direct and indirect Ophthalmoscopy (mydriatic) B-scan

Intraocular foreign body - treatment Magnetic IOFB In the anterior chamber In the lens In the posterior part of the globe Non–magnetic IOFB

Review Classification of ocular injury ? Harm of penetrating injury of the globe ? Treatment of penetrating injury of the globe ?