1. ORBIS International

2. Ocular Trauma Alice Lee RN Canada

3. Corneal abrasions Foreign bodies Radiation damage Chemical damage
Injuries to the Eye
Corneal abrasions
Foreign bodies
Radiation damage
Chemical damage
Blunt Injuries
Penetrating injuries

4. History High velocity injury? suspect a penetrating injury
Forceful blunt injury?
look for signs of a blow out fracture

5. History Visual History History: Symptoms Is one or both eyes affected?
Vision at the time of the examination?
Vision before trauma?
History: Symptoms
Symptoms besides decreased vision?
Duration of symptoms?
Any surgery prior to trauma?

6. Examination Visual Acuity Fluorescein Distorted Pupil
Range of Extraocular Motion
Depth of Anterior Chamber
Lacerations?
Presence of hemorrhage
Presence of Cataract

7. Corneal Abrasion Common result of a blunt injury
May be missed if Fluorescein is not used
Common result of a blunt injury
May be missed if Fluorescein is not used

8. Aims of Treatment Corneal Abrasion Relieve pain: - Topical anesthesia
- Cycloplegic drops
Prevent infection:
antibiotic ointment
Protect the eye:
- Pressure patch

9. Foreign Bodies
Conjunctival Corneal Intraocular
Examination: fluorescein, anaesthetic drops, evert lids to check conjunctiva and cornea
Irritation/Pain
Tearing
Red eye
History of Foreign Body
entry
Photophobia if on or
rubbing on cornea

10. Treatment Foreign Bodies
Conjunctival lift out with moist cotton sterile applicator
Corneal dislodge with irrigation or using needle
Antibiotic ointment
With larger foreign bodies
may treat as for a corneal
abrasion: patch the eye

11. Intraocular Foreign Bodies
May penetrate the globe without causing severe pain, obvious physical signs, or early visual disturbances
Require immediate treatment
Dilate pupil for examination
of lens, vitreous, retina
Systemic & topical antibiotics
Shield eye - no pressure

12. Treatment: same as for corneal abrasion
Radiation Damage
Welding with inadequate protection
hours after: painful, tearing eyes
Exposure to large amounts of reflected sunlight
Treatment: same as for corneal abrasion

13. Chemical Damage
Chemical burns of the cornea & conjunctiva can be serious
Immediately wash eye out with water
Remove loose particles
Chemical iritis: instill a long-acting
cycloplegic (atropine 1%)
Corneal epithelial defects: antibiotic
ointment, patch
Analgesia
Prompt referral to ophthalmologist

14. Acid Burns
minutes later
3 months later

15. Alkali Burn Acute Stage conjunctival chemosis
mild corneal opacification
Chronic Stage
total corneal opacification
corneal vascularization

16. Small object Blunt Trauma Injuries
Impact may be taken by the eye and orbit

17. Blunt Trauma Injuries - Small object
Complications
Damaged Pupil react
poorly to light
Damaged/Dislocated Lens
Damage to the Drainage
Angle
Ruptured Globe
Hemorrhage in A/C
(Hyphema) in vitreous or
retina

18. Blunt Trauma Injuries
Large object
Impact is taken by the orbital rim

19. Upward and downward gaze limited by tethered muscle
Blunt Trauma Injuries
Complications
Upward and downward gaze limited by tethered muscle
Blow – out Fracture
usually occurs in orbital floor
Prolapse into the orbital floor fracture

20. Signs of an Orbital Blowout Fracture

21. Globe Laceration
One of the most serious injuries of blunt trauma

22. Ruptured Globe - Treatment
Alleviate pain
Dilate pupil
Protective shield
Local (drops) & systemic antibiotics
Refer for ophthalmic surgery

23. Signs Penetrating Injuries
Should be suspected with any high velocity injury
Can be missed as the wound may seal itself
Signs
Distorted pupil
Cataract
Vitreous hemorrhage

24. Penetrating Injuries
Treatment
No pressure on globe

25. Refer if Lid Lacerations lid margins have been torn
lacrimal ducts have been damaged
suspect a penetrating eyelid injury

26. Prevention of Injuries
Patient Education
Protective eye wear: contact, ball or raquet sports, when working at occupations in which eye trauma is likely
Goggles: when working with chemical sprays, cleaning fluids, power tools, fireworks, etc
Sunglasses: 100% UV blockage when in bright sunlight
Never look directly at the sun, an eclipse, or an arc welding lamp

27. Thank you