1. Ocular Trauma Sandra M. Brown, MD 1 and Yair Morad, MD 2 1 Ophthalmology and Visual Sciences Texas Tech University Health Sciences Center Lubbock, Texas USA 2 Pediatric Ophthalmology Service, Assaf Harofeh Medical Center, Zrifin, Israel

2. Nature of Injury Blunt Lacerating Chemical

3. Blunt Trauma Mild – moderate –“Bruise” ocular tissues –Eye wall intact Moderate – severe –Rupture eye wall –Very severe consequences

4. Lacerating Trauma “Cut” eye wall Outcome depends on extent and location

5. Location of Injury Anterior segment Posterior segment Adnexa Orbital structures

6. Anterior Segment Conjunctiva Cornea Iris Lens

7. Posterior Segment Vitreous Retina Optic nerve

8. Adnexa Eyelids Lacrimal Structures

9. Orbital Structures Extraocular muscles Bony walls

10. Disgusting Photographs Front to back…

11. Racoon Eye Self limiting if no other injury exists No treatment needed Be sure to open lids apart to examine the eye structure and motility

12. Lid Laceration

13. Lacrimal Duct Laceration Repair ASAP Probing with silicon tube and suturing

14. Conjunctival Trauma Sub conjunctival hemorrhage –Self limiting –No treatment needed Conjunctival laceration –Make sure the sclera is intact –Antibiotic ointment for 1-3 days

15. Subconjunctival Hemorrhage

17. External Foreign Body Can be in conjunctiva or cornea Red painful and watery eye Removal under slit lamp Patching with antb

18. Corneal Foreign Body

20. Corneal Abrasion Severe pain and photophobia Blurry vision Erosion stains with fluresceine Patching with antibiotic oint to prevent infection and help re- epithelization Healing 1-4 days

21. Corneal Abrasion

22. Chemical Burn Usually fat-cleaning materials Pain, photophobia Treatment: irrigation, irrigation, irrigation

23. Corneal Penetration Minor wound can be self sealing and leave the eye intact Patient complains on photophobia and pain Only on slit lamp examination perforation is diagnosed

24. Corneal Perforation -Cont Iris can be captured in the perforation wound Iris reposition if soon after the injury and corneal suturing

26. Hyphema Blood in anterior chamber Sometimes hard to diagnose Blurry vision and pain Self limiting Complications: elevation of intra-ocular pressure and re-bleeding

27. Traumatic Cataract Usually repaired in a secondary operation If possible a plastic intra-ocular lens is inserted instead of the damaged lens Treatment of amblyopia crucial

28. Traumatic Cataract

29. Vitreous Hemorrhage Blood in vitreous cavity Usually self limiting Can be cleared with vitrectomy is rare occasions

30. Retinal Hemorrhage

31. Optic Disc Hemorrhage

32. Intra-ocular Foreign Body Ocular emergency Removal in vitrectomy Retained FB can cause infection or retinal degeneration

33. Orbital Wall Fracture Problematic only if: –Limitation of eye ductions –Disfiguring enophthalmos

34. Traumatic Optic Neuropathy Optic nerve injured in optic canal Usually vision loss No good treatment Mega-dose steroids?

35. Common Minor Eye Injuries Corneal abrasion Corneal foreign body Chemical splash Traumatic iritis

36. Diagnosis History –Sharp vs blunt vs chemical injury Exam –CHECK VISION

37. Diagnosis cont. Exam – open lids apart! –Cornea clear? –Pupil round? –Pupil black? –Blood clotted behind cornea?

38. Diagnosis cont. Exam –Red reflex? –Eyes move symmetrically?

39. Fluorescein Test Topical “eye dye” COBALT light

40. Corneal Abrasion

41. Abrasion Treatment Antibiotic ointment +/- patch 1-2 day follow-up with eye doc

42. Corneal Foreign Body

43. Foreign Body Treatment Anesthetize eye Remove FB –Cotton swab (don’t worsen abrasion!) –Kimura spatula –+/- needle tip Antibiotic oint +/- patch 1-2 day follow-up with eye doc

44. Chemical Treatment IRRIGATE with large amounts of water Check PH Minor –Antibiotic ointment –1 day follow-up eye doc Major –Same day evaluation by eye doc

45. Traumatic Iritis Moderate blunt injury Photophobia Lid bruising/edema Subconjunctival hemorrhage or injection Pupil sluggish Evaluation by eye doc

46. Please Do Not Confuse Subconjunctival hemorrhage Hyphema