1. Ocular Trauma
Dr.saif alshamarti

2. Ocular Trauma Orbital wall fracture. Lid lacerations.
Chemical injuries.
Blunt ocular trauma.
Penetrating ocular trauma.
Superficial & intraocular foreign body.

3. Blow out fracture
A blowout fracture is a fracture of the walls of the orbit
(inferior, medial ,lateral &roof). Intraorbital material may be pushed out into one of the paranasal sinuses. This is most commonly caused by blunt trauma of the head

4. Orbital floor fracture
Commonest orbital fracture.
Usually following blow from an object greater than 5 cm( eg.tennis ball /fist).
The force transmitted by hydraulic compression of the globe/orbit structure (blow- out)
C/F: 1.bruising,odema &haemorrhage.
2.Surgical emphysema.
3.Vertical diplopia.
4.Enophthalmus Infraorbital anesthesia.

6. Restriction on upgaze due to trapping of the inferior rectus muscle by connective tissue septa in the fractured site.
Restriction on upgaze due to trapping of the inferior rectus muscle by connective tissue septa caught in the fractured site.
The inferior orbital floor is the most commonly fractured site. .

7. Tear Drop Sign

8. Medial wall fracture
Rare as isolated fracture but they may accompany orbital floor fracture.
Same soft tissue signs But surgical emphysema more prominent.
Horizontal diplopia.

9. Orbital roof fracture
Very rare as an isolated feature . most commonly seen in children following brow trauma.
Bruising may spread across midline.
Superior subconjunctival hemorrhage with no distinct posterior limit.
Glob displacement (axial or inferior).
Bruit/Pulsation of the globe due to communication with CSF.
Risk of meningitis.

10. Lateral wall fracture(zygomatic arch).
Only seen following significant maxillofacial trauma.

11. Eyelid Lacerations Occurs in both blunt &sharp injuries
Consult ophthalmology for:
1. Laceration through lid margins – risk of entropion/ectropion.
2. Deep lacerations – risk of ptosis
3. Injury of medial 1/3 of lid margin – risk of lacrimal duct injury

12. Globe Rupture Signs of occult globe rupture
Hypotonia – (IOP < 5mmHg).
Generally tonometry is not recommended in suspected globe rupture.
Seidel Sign
Streaming & clearing of fluorescein away from injury
Peaked Pupil
Teardrop shaped pupil – iris moves to patch leaking sclera
Bloody chemosis – bulging of conjunctiva
Hyphema – trauma to blood vessel of iris
Scleral smudge – disrupted sclera reveals choroid below

13. Globe Rupture
Seidel Sign: leaking aqueous humor dilutes fluorescein dye

14. Globe Rupture
Peaked Pupil

15. Globe Rupture Treatment : 1. Eye shield placed over affected eye
2. CT head and face (orbits), if stable, to evaluate for:
Orbital wall fractures
Open globe injury
Intraocular foreign body
3. Anti-emetics:
Even if pt is not nauseous. Vomiting or valsalva will increase IOP and may cause extrusion of globe contents.
4. Tetanus prophylaxis.
5. Systemic antibiotics (cover Staph & Strep).
Fluoroquinolones, aminoglycosides & cephalosporins

16. Corneal abrasion: It’s the most common eye injury
is a medical condition involving the
loss of the surface epithelial layer of
the eye’s cornea
It’s the most common eye injury
and perhaps one of the most
neglected , it occurs because of a
disruption of the integrity of
corneal epithelium because the
corneal surface scraped away as aresult of physical external forces.

17. Corneal abrasion cont.
They usually heal without serious consequences, although deep abrasion can result in scar formation in the stroma.
Examples about causes of corneal abrasion :
corneal or epithelial disease (eg, dry eye), superficial corneal injury or ocular injuries (eg, those due to foreign bodies), and contact lens wear .

18. Corneal abrasion cont. Most patients present with the following:
Photophobia
Watering
Foreign body sensation
Gritty feeling
Pain.

19. Corneal abrasions cont.
Treatment:
Antibiotics
Cycloplegic agent .
Lubrication
AVOID STEROIDS.
Patching ???
Topical NSAIDS drops
Debriding loose or hanging epithelium

20. Foreign bodies
Corneal foreign body is foreign material on or in the cornea, usually metal, glass, or organic material.

21. Corneal foreign bodies:
Symptoms
Foreign body sensation, Tearing,photophobia , pain , red eye
Signs
Corneal foreign body with or without rust ring, edema of the lids, conjunctiva, and cornea, foreign body can cause infection and/or tissue necrosis.

22. Corneal foreign bodies cont.
Treatment
1.Apply topical anesthetic, remove the foreign body with a forceps at a slit lamp. If multiple superficial foreign bodies, its easier to remove with irrigation.
2.Remove the rust ring. This may require an ophthalmic drill.
3.Measure the size of the resultant corneal epithelial defect.
4.Treat as for corneal abrasion.

23. Subconjunctival hemorrhage:
Is bleeding underneath the conjunctiva. The conjunctiva contains many small, fragile blood vessels that are easily ruptured or broken. When this happens, blood leaks into the space between the conjunctiva and sclera. Symptoms Red eye, may have mild irritation, usually asymptomatic Signs Blood underneath the conjunctiva, often in a sector of the eye. The entire view of the sclera may be obstructed by blood. Causes Valsalva (e.g., coughing or straining), Trauma, HTN, Bleeding disorder, Hemorrhage due to orbital mass (rare), Idiopathic.
Subconjunctival hemorrhage (bleeding): Generally, this condition is painless. Vision is not affected. The eye will have a red spot of blood on the sclera (the white part of the eye). This occurs when there is a rupture of a small blood vessel on the surface of the eye. The area of redness may be fairly large, and its appearance is sometimes alarming. It is not dangerous and generally goes away slowly with no treatment

25. Subconjunctival hemorrhage cont.
Workup -History: Bleeding or clotting problems? Medications (e.g., aspirin, warfarin)? Eye rubbing, trauma, heavy lifting, Valsalva? Recurrent Subconjunctival Hemorrhage? Acute or Chronic cough (COPD)? -Check Vital signs. -History of recurrence or bleeding problem; order Bleeding time, PT, PTT, CBC. -Positive Orbital signs: CT scan with and without contrast

26. Subconjunctival hemorrhage cont.
-Ocular Examination: Rule out a conjunctival lesions, Check IOP, and Check extraocular motility.
In traumatic cases you should rule out: Ruptured Globe (Abnormal deep ant. Chamber, Significant SCH, Hyphema, Vitreous hemorrhage, or prolapse of uveal tissue) .
Retrobulbar Hemorrhage (Exophthalmus, Increased IOP, and chemosis)
Orbital Fracture (Limited extraocular eye motility, eno- or exo-phthalmus, preiorbital crepitus, paraesthesia.

27. Hyphema Complications: Outpatient management Corneal staining
glaucoma (blockage of Canal of Schlemm)
Rebleed
Outpatient management
Eye rest, pain-control and antiemetics (no NSAIDS )
Hard eye shield
Stop anticoagulation Rx
Sleep sitting up.
Antibiotics &steroid

28. Chemical burn (injury)
Most chemical substances that come in contact with the conjunctiva or cornea cause little harm.
The chief danger comes from alkali-containing compounds found
in household cleaning fluids, fertilizers and pesticides. They erode and opacify the cornea.
Acid-containing compounds (battery fluid, chemistry labs) are somewhat less dangerous.
There are no antidotes to these chemicals. The best you can do is to dilute them immediately with plain water.
The resultant reaction of the tissue causes the damage.

29. Chemical burn (injury) cont.
Treatment should be instituted immediately, even before testing vision.
Emergency treatment:
1-copious irrigation of the eyes, preferably with saline or ringer lactate.
Don’t use acidic solutions to neutralize alkalis or vice versa.
Pull down the lower eyelid and evert the upper eyelid to irrigate the fornices
2-irrigation should be continued until neutral PH is reached.
The volume of irrigation fluid required to reach neutral PH varies with the chemical and the duration of the chemical exposure

30. Chemical burn (injury) cont.
For severe burns (Treatment after irrigation):
Admission to the hospital Lysis of conjunctival adhesion
Debride necrotic tissue
Topical antibiotic
Topical steroid
Antiglaucoma medication if the IOP is increased or cant be determined
Frequent use of preservative free artificial tear
Other consideration:
Therapeutic contact lenses, amniotic membrane transplant
If the melting progresses an emergency patch graft or corneal transplant may be necessary.

31. Chemical burn (injury)
A hazy cornea following an alkali burn

32. Ocular Trauma