1. CGI & Chemical injuries OF THE EYE
Ayesha S Abdullah

2. Learning outcomes
By the end of this lecture the students would be able to
Differentiate between OGI and CGI
Diagnose CGI of the eye, identify its complications and outline the principles of management of these injuires specially in case of hypahema
Describe the epidemiology of chemical ocular injuries, correlate the pathophysiology of chemical injury with acids and alkali to the clinical presentation & complications , Explain the first aid measure and later management of a case with chemical injury.
Identify the complications of chemical injury and correlate it with the underlying pathology, suggest ways for the primary, secondary and tertiary prevention of such injuries

3. Close globe injury (CGI)
Definition
Mechanism
AP compression
Expansion in the equatorial plan
Transient & excessive increase in IOP
Impact is primarily absorbed by ??
Lens –Iris diaphragm & vitreous
The damage can happen to any tissue of the eye
Commonly has long-term effects/ sequelae

6. Close Globe Injuries Choroidal tear Commotio retinae
Subconjunctival Haemorrhage
Corneal abrasion
Acute corneal oedema
Traumatic iritis
Traumatic Mydriasis / Miosis
Hyphaema
Iridodialysis
Cyclodialysis /
Angle recession
Ciliary shock
Choroidal tear
Commotio retinae
Posterior Vitreous Detachment
Vitreous haemorrhage
Retinal tears
Retinal Detachment
Optic Nerve Evulsion

7. Close Globe Injuries 5-6-6 Conjunctiva, Cornea & Lens
Subconjunctival Haemorrhage
Corneal abrasion
Acute corneal oedema
Subluxation and dislocation of lens
Cataract
Iris & IRCA
Traumatic iritis
Traumatic Mydriasis / Miosis
Hyphaema
Iridodialysis
Cyclodialysis / Angle recession
Ciliary shock
Posterior Segment
Choroidal tear
Commotio retinae
Posterior Vitreous Detachment
Vitreous haemorrhage
Retinal Breaks & Retinal Detachment
Optic Nerve Evulsion
5-6-6

8. Hyphaema Source of bleeding? Iris /ciliary body / both
Immediate threat –
Secondary haemorrhage
Can happen up to a week, mostly first 24 hrs
The haemorrahge is larger than the original bleed
Most common problem is raised intraocular pressure

9. Hyphaema
Most hyphaemas resolve without complications but complications can happen with long standing cases
The most vision threatening complications are,
secondary glaucoma
optic nerve damage
corneal staining
The greater the extent of hypahema greater the chances of complications i.e blood filling more than half of the AC

10. Treatment of Hyphaema
Small (less than 1/3rd of the AC) can be managed at home
Larger hyphaema requires hospitalization for closer monitoring to avoid secondary bleed and complications
For lowering the IOP; beta blockers, Alpha agonist , Carbonic Anhydrase (CA) inhibitors
For associated traumatic uveitis; topical steroids
Immobilization of the iris in the dilated position to avoid secondary haemorrhage; mydriatics

12. Hyphaema

14. Other injuries with blunt trauma
Corneal abrasion/ ulcer

15. Other injuries with blunt trauma
Corneal abrasion/ ulcer

16. Subconjunctival haemorrhage

17. Iridodialysis and angle recession

18. Traumatic mydriasis

19. Subluxation and dislocation of the lens

20. Posterior segment complications- retinal Hge, vitrous Hge, Retinal tear and RD (B scan)

21. Posterior segment complications
Choriodal breaks and scars
Commotio retinae (Berlin’s oedema )
Optic nerve evulsion

22. Black Eyes- Ecchymosis

23. Panda Eyes
Fracture base of the skull

24. Case
Gul Nawaz aged 35 years presented to emergency deparment with injury to the right eye while working in a cement factory. He had severe ocular irritation with watering, pain and photophobia.
The eye was extensively washed till the normal pH was restored
On examination VA OD=CF 1 m, OS=6/5
He had red eye with corneal haze
There was limbal ischemia affecting less than 1/3rd of the limbus (3 clock hours)
The IOP was 24 mmHg OD, 11 mmHg OS
Examine the given photograph

26. Questions What kind of injury is this- Acid/ Alkali?
Would it make any difference?
Which is more common- Acid or Alkali injury?
Why was the eye washed first?
What is limbal ischemia and what is its significance in this patient?
Why was the IOP raised?
What would be the prognosis of this kind of injury?
What complications immediate (primary) and late (secondary) can happen?

27. Some more Questions
Which is the commonest alkali responsible for ocular burns?
Name the alkali that causes the most serious ocular injury?
Which is the commonest acid responsible for ocular burns?
Name the acid that causes the most serious ocular injury?
List 5 Common sources of alkali and acids.

28. List three factors that determine the severity of chemical burns of the eye.
How does corneal healing happen in a case of chemical corneal burn?
List 5 ocular examinations that you must perform to ascertain the degree of chemical injury of the eye.
What are the principles of management of chemical ocular burns?
What is the first aid management of chemical ocular injury?

29. Grade the following ocular chemical burns1

30. 2

31. 3

32. 4

33. 5

34. 6