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Ocular Injury Department of Ophthalmology
Tianjin Medial University General Hospital Hua Yan, MD, PhD
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General description The structure of the visual organ
is very fine and weak Lose the ability to work Difficulties and sufferings in life Prompt and right management
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Classification of ocular injury
Mechanical ocular injury Contusion Laceration Rupture Non-mechanical ocular injury ocular chemical burns thermal burns radiation damage
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Classification of mechanical ocular injury
Closed injury Open injury Contusion Laceration Rupture Penetrating IFB Perforation Lamellar laceration
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Mechanical injury of the eye
Make up more than 80% of the total injuries metal fragment, instruments in work, knife, scissors, needle, pliers, shells, ears of wheat and grain, spots instruments, toys at home, explosive flying stone, iron piece, shell fragment in battlefield
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Mechanical injury of the eye
Take place young workers students youth people short of experience in work
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Orbital Injury
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Orbital injury - clinical findings
Fracture of orbital wall and nearby cranial bone, nasal sinuses and optic canal (leading to optic nerve atrophy) Fracture of the ethmoid sinus (subcutaneous emphysema) Injuries of the eyelids, the globe and deep soft tissue of the orbit (orbital cellulitis) Intraorbital hemorrhage may induce exophthalmos and palpebral ecchymoma
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Orbital injury - treatment
Complications of nervous or systemic system - management Closed simple fracture of the orbital bony rim - no special treatment Severe injury of skull, reflex of the pupil should be examined Severe injury of soft tissue - debridement and suturing layer, TAT and antibiotic Large foreign body in the orbit should be extracted as early as possible Small and deep ones, generally extractive operation isn’t needed. Intraobital hemorrhage - pressure bandage
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Palpebral injury
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Palpebral injury - clinical findings
Palpebral skin is thin and loose, it is quite easy to be healed after injury and the infection is rare Palpebral swelling and hemorrhage Subconjunctival hemorrhage may spread into the subcutaneous tissue of another eye through the nose bridge Breakdown of the palpebral margin Breaking of ligaments of the inner and outer canthi
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Palpebral injury - treatment
The palpebral edema and hemorrhage may be absorbed spontaneously Fresh wound must be debridement and sutured as early as possible Tetanus antitoxin (TAT) Antibiotic
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Conjunctival foreign body - clinical findings
Dust, coal dust and small insect Most of the foreign bodies are pushed into the inferior tarsal sulcus of the upper eyelid Foreign body sensation, pain, tearing, and palpebral spasm Conjunctival hyperemia Eyelid is everted, fine foreign body often lodges in the lower tarsal sulcus of the conjunctiva in the upper eyelid
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Conjunctival foreign body - treatment
Removed by wet cotton roll or clean towel
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Corneal foreign body
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Corneal foreign body - etiology
Metal pieces Dust in atmosphere Insects Husks Explosive injury
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Corneal foreign body - clinical findings
Foreign body sensation Pain Photophobia Tearing Palpebral spasm
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Corneal foreign body - treatment
Don’t rub the eye Remove with cotton-tipped applicator after surface anesthesia with 0.5%-1% dicaine solution After several hours of existing, an iron pieces arouses siderosis on its surrounding tissue Rust is difficult to be removed clearly
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Penetrating injury of the globe
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Penetrating injury of the globe
Beat something with a hammer, splashing pieces to eye The severity of penetrating injury is related to many factors Size Shape Character of instruments causing trauma Splashing velocity Injured site Polluted degree
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Penetrating injury of the globe – clinical findings
Direct damage to ocular tissue Corneal penetrating injury Prolapse of intraocular contents Secondary glaucoma Traumatic cataract Intraocular hemorrhage
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Severity of penetrating injury
Endophthalmitis---Intraocular infection Intraocular foreign body Inflammatory reaction Metal foreign body may harm intraocular tissue Sympathetic ophthalmia Sometimes penetrating injury or intraocular foreign body in one eye leads to severe uveitis in another eye which is called sympathetic ophthalmia
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Penetrating injury of the globe - treatment
Don’t squeeze injured eye on examination Emergency treatment clean the wound instill antibiotic ointment and bandage both eyes transmit the wounded to hospital in time tetanus antitoxin Corneal, scleral wound should be sutured as early as possible As for corneal or scleral wound with prolapse of the uvea, if it is within 24 hours, the wound is clean, the prolapsed tissue may be replaced into the eye
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Penetrating injury of the globe - treatment
In order to prevent iris incarceration, injection of air into the anterior chamber should be done For the corneal line wound which is less than 3mm with no incarceration, the anterior chamber is restored all or partially, suture isn’t needed Minor and closed scleral wound needn’t be sutured Inject antibody into subconjunctiva Examination next day
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Intraocular foreign body
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Intraocular foreign body
Commonly occurred in eye injury Steel, iron, copper, non – metal foreign body In the anterior chamber, lens, vitreous, incarcerated in the retinal and uvea Stable substance such as gold, silver, glass, stone and etc may lead to simple exudative reaction surrounding the foreign body Steel and iron within the eye bring about severe reaction
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Intraocular foreign body - diagnosis
Injury history Signs Ocular examination X ray CT
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Preoperative examinations
Visual acuity Slit lamp examination Direct and indirect Ophthalmoscopy (mydriatic) B-scan
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Intraocular foreign body - treatment
Magnetic IOFB In the anterior chamber In the lens In the posterior part of the globe Non–magnetic IOFB
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Review Classification of ocular injury ?
Harm of penetrating injury of the globe ? Treatment of penetrating injury of the globe ?
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