Jasmin Jiji B. Miranda ASMPH LEC Group 8 Ophthalmology Clerkship Rotation: QMMC Ocular and Orbital Trauma

References Vaughan & Asbury’s General Ophthalmology 17 th ed. ASMPH Ophthalmology Lecture Notes on “Ocular and Orbital Injuries/Emergencies” by Dr. Nonette Pasco-Rosete. January

Outline Initial Examination of Eye Trauma ER Management Lid Lacerations Foreign Bodies Corneal Lacerations/Abrasions Penetrating Injuries and Contusions of the Eyeball o Globe Rupture Burns of the Eye Orbital Fractures

3-DAY OPHTHALMOLOGY OPD (SERVICE) CLERKS' CENSUS N = 62

Initial Examination HISTORY o mechanism of injury abrasion, blunt force, penetrating object, burns o symptoms o time of the injury o visual acuity prior to the injury

Initial Examination PE: o Visual acuity o Eye examination o Including uninjured eye o Photodocumentation for medicolegal purposes Labs and imaging

ER Management Stabilize patient Obtain history Address eye injury Avoid unnecessary manipulation oUse medications with caution Chemical burns: IRRIGATE Check pH: 7.0 to 7.4

Lid Laceration PLAN Primary repair + Antibiotics + Analgesics Canalicular injury: silicone nasocanalicular intubation

Foreign Bodies PLAN Removal of foreign body Surgical intervention Infection coverage + eye patch Inert: glass, rubber, stone Inflammatory: Iron, steel, organic material

Corneal Lacerations/Abrasions

Positive Seidel Test PLAN Antibiotic coverage Artificial tears Cyclopegics Patching (banding effect)

Ruptured globe Lid margin lacerations, cornea- scleral laceration, and prolapsed uvea May require enucleation to reduce risk of sympathetic ophthalmia

Globe Rupture: Left Eye Shallow anterior chamber Hyphema Traumatic cataract Vitreous hemorrhage Vitreous rupture

Contusions of the Eyeball Hyphema Subconjunctival Hemorrhage Iridodialysis

Injury to the Posterior Structures Vitreous Hemorrhage Retinal Detachment Choroidal Rupture

Chemical Burn PLAN Irrigation Debridement Cyclopegia Antibiotic Artificial tears

Thermal Burn Examples: Curling Iron Burn. UV Irradiation. Sun Viewing. X-ray Radiation. Plan: Pressure patching and antibiotics.

Orbital Fracture/ Periorbital Contusion Hematoma Fracture fragments and herniation of periorbital tissues into the maxillary sinus

Blow-out Fracture Superior rim: Traumatic Optic Neuropathy

Know when to repair. Know when to refer.