1. Caring for patients with eye injuries, neoplastic growth of the eye. Lecturer: Lilya Ostrovska

2. Ocular Trauma

3. Nature of Injury  Blunt  Lacerating  Chemical

4. Blunt Trauma  Mild – moderate  “bruise” ocular tissues  Eye wall intact  Moderate – severe  Rupture eye wall  Very severe consequences

5. Lacerating Trauma  “cut” eye wall  Outcome depends on extent and location

6. Location of Injury  Anterior Segment  Posterior Segment  Adnexa  Orbital Structures

7. Anterior Segment  Conjunctiva  Cornea  Iris  Lens

8. Posterior Segment  Vitreous  Retina  Optic nerve

9. Adnexa  Eyelids  Lacrimal Structures

10. Orbital Structures  Extraocular muscles  Bony walls

11. Disgusting Photographs  Front to back…

12. Racoon Eye

13. Lid Laceration

14. Subconjunctival Hemorrhage

16. Corneal Foreign Body

18. Corneal Abrasion

19. Curling Iron Burn

20. Corneal Laceration

22. Iris Sphincter Rupture

23. Hyphema

24. Traumatic Cataract

25. Vitreous Hemorrhage

26. Retinal Hemorrhage

27. Optic Disc Hemorrhage

28. Orbital Wall Fracture

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

30. Diagnosis  History  Sharp vs blunt vs chemical injury  Exam  CHECK VISION

31. Diagnosis cont.  Exam – Pry lids apart!  Cornea clear?  Pupil round?  Pupil black?  Blood clotted behind cornea?

32. Diagnosis cont.  Exam  Red reflex?  Eyes move symmetrically?

33. Fluorescein Test  Topical “eye dye”  COBALT light

34. Corneal Abrasion

35. Abrasion Treatment  Erythromycin ointment  +/- patch  1-2 day follow-up with eye doc

36. Corneal Foreign Body

37. Foreign Body Treatment  Anesthetize eye  Remove FB  Cotton swab (don’t worsen abrasion!)  Kimura spatula  +/- needle tip  E-mycin and +/- patch  1-2 day follow-up with eye doc

38. Chemical Splash

39. Chemical Treatment  IRRIGATE  Check pH  Minor  E-mycin ointment  1 day follow-up eye doc  Major  Same day eval by eye doc

40. Traumatic Iritis  Moderate blunt injury  Photophobia  Lid bruising/edema  Subconj heme or injection  Pupil sluggish  Eval by eye doc

41. Please Do Not Confuse  Subconjunctival hemorrhage  Hyphema

42. OCULAR ONCOLOGY

43. OSSN  Ocular surface squamous neoplasia  Encompasses conjunctival/corneal intraepithelial neoplasia (CIN)  Squamous conjunctival dysplasia  Carcinoma in situ  Invasive squamous cell carcinoma (SCC)

44. Squamous cell carcinoma Extensive Ill defined edges Vascularised Corneal involvement

45. Conjunctival melanoma  Primary aquired conjunctival melanosis (PAM)  Preexisting conjunctival naevus  De novo

46. PAM Biopsy if: Growth Nodule formation Vascularity  Primary acquired conjunctival melanosis

47. De novo conjunctival melanoma

48. Rx Conjunctival SCC / Melanoma  Excision / cryotherapy to cut conjunctival margin  Topical Mitomycin C  Episcleral plaque radiotherapy if recurrence

49. Iris melanoma

50. Congenital hypertrophy of the retinal pigment epithelium (CHRPE)

51. Choroidal neovascularisation: high myopia (Fuch’s spot)

52. Choroidal haemangioma

53. Melanocytic tumours of the posterior uvea  Naevus  Melanoma

54. Drusen Fibrous metaplasia of RPE Choroidal naevus

55. Uveal melanoma treatment  Observation Tumours < 2mm thick

56. Symptoms Thickness > 2mm Orange pigment (lipofuscin) Growth Subretinal fluid Peripapillary location

57. Uveal melanoma treatment Observation  Transpupillary laser thermotherapy (TTT)

59. Uveal melanoma treatment  Observation  TTT  Local resection Anterior to equator Base < 10mm

60. Uveal melanoma treatment  Observation  TTT  Local resection  Radioactive plaque therapy Thickness < 8mm Base <15mm

61. Ruthenium 106 Iodine 125

64. Uveal melanoma treatment  Observation  TTT  Local resection  Radioactive plaque therapy  Proton beam/helium ion irradiation  Gamma knife therapy

65. Uveal melanoma treatment  Observation  TTT  Local resection  Radioactive plaque therapy  Proton beam/helium ion irradiation  Gamma knife therapy  Enucleation Base > 15mm

66. Metastatic tumours  Breast / lung carcinoma  Amelanotic  Multifocal  Choroidal  Treat only if sight affected

67. Amelanotic Multifocal Choroidal Posterior to equator

69. THANKS FOR YOUR ATTENTION !