1. Visual prognosis among traumatic hyphemas
RED EYE and TRAUMA
Visual prognosis among traumatic hyphemas
Percent with final acuity
No. of
Patients
Degree of hyphema
>20/ <20/200
Hyphemas are serious! Note the percentage of patients who end up legally blind after 8 months. This is not due to blood in the anterior chamber but rather to collateral damage from the original trauma.
Partial hyphema
Total hyphema
All hyphemas
191 36
227 77 33 70 16 55
22.5
8 month followup Am J Ophthal 5: 1, 1973

2. With muscle entrapment
RED EYE and TRAUMA
OCULAR TRAUMA
Orbital wall fractures
Note the enophthalmos and exotropia. The secondary diplopia is the most incapacitating symptom.
With muscle entrapment

3. Classic blowout fracture of orbital floor and ethmoids
RED EYE and TRAUMA
Classic blowout fracture
of orbital floor and ethmoids
X-ray of the orbits of the previous patient. Note the opacification of the ethmoid sinus, the fluid level in the maxillary sinus, and the orbital tissue projecting through the floor into the antrum on the right side.

4. OCULAR TRAUMA Muscle entrapment Orbital floor fracture
RED EYE and TRAUMA
OCULAR TRAUMA
Muscle entrapment
Orbital floor fracture
This illustrates how the inferior rectus can become trapped. It must be surgically released to allow single vision.

5. RED EYE and TRAUMA
OCULAR TRAUMA
Entrapment of inferior rectus muscle following blowout fracture
The inferior rectus on the left side is trapped, limiting vertical movement.

6. OCULAR TRAUMA Foreign bodies RED EYE and TRAUMA
Remember, not all ocular foreign bodies are found on the globe itself!

7. RED EYE (Rule out trauma) Foreign bodies Organic Metallic
RED EYE and TRAUMA
RED EYE
(Rule out trauma)
Foreign bodies
Organic
Metallic
Foreign bodies may be composed of any materials.

8. Corneal foreign bodies RED EYE and TRAUMA
Note the rust and surrounding corneal edema on the high power view that is not evident from simple naked inspection.

9. Now what? RED EYE and TRAUMA
Note the amount of rust remaining after the foreign body is removed. Iron is toxic to cells and prevents healing of the epithelial defect.

10. TO PATCH, OR NOT TO PATCH Cumulative incidence of corneal healing
RED EYE and TRAUMA
Cumulative incidence of corneal healing
Patched
N=82
Non-patched
N=81
Probability of corneal healing
Patching does not speed epithelial healing and is generally applied only when a third or more of the epithelial surface has been removed.
After 1 day
After 2 days
After 3 days
0.51
0.78
0.92
0.60
0.83
0.98
Le Sage, et al: Annals Emerg. Med. 38: , 2001

11. Wrong Right RED EYE and TRAUMA
Patching is only useful when applied as a semi-pressure patch that maintains closure.

12. Never patch more than 12 hours
RED EYE and TRAUMA
Never patch more than 12 hours
Remember, when you patch the eye closed, you are creating a perfect incubator for the native bacteria to thrive and multiply!
Use antibiotic ointment

13. Semipressure patch RED EYE and TRAUMA
This semi-pressure patch is only applied correctly if the right eye remains closed upon opening the left one.

14. OCULAR TRAUMA Corneal abrasions RED EYE and TRAUMA
Note that fluorescein is useful in delineating the extent of the abrasion.

15. Fingernail damage RED EYE and TRAUMA
Corneal abrasions occur in many ways.

16. Curling iron Cigarette burn RED EYE and TRAUMA
Another reason not to smoke!

17. Airbag abrasions RED EYE and TRAUMA
A more modern technique to produce corneal abrasions.
Airbag abrasions

18. OCULAR TRAUMA Chemical burns RED EYE and TRAUMA
Chemical burns are often devastating even though the initial presentation does not appear serious. The photo on the right was taken 3 months after the acute lye burn seen on the left photo.

19. BLUNT TRAUMA Retinal tears RED EYE and TRAUMA
Retinal holes occur in many forms, from atrophic thinning to horseshoe tears, and dialyses of the vitreous base.

20. RETINAL VISUALIZATION
RED EYE and TRAUMA
RETINAL VISUALIZATION
Limited views
Traumatic retinal tears are usually located far anteriorly and out of the view of the direct ophthalmoscope.

21. BLUNT TRAUMA Retinal edema (commotio retinae) RED EYE and TRAUMA
While this looks rather awful, the edema may disappear completely and vision can return to normal. This picture is often seen in crushing chest injuries such as that caused by the steering wheel in a MVA.