1. TMA Department of eye diseases Medical emergency in ophtalmology Medical emergency in ophtalmology

2. The purpose of the training session: Ocular traumas make from 5% to 10% of all eye diseases. Due to this fact the main goal of our lecture is to convince GP in necessity of acquiring knowledge in the questions of etiology, pathogenesis, clinics, diagnostics, treatment and prophylaxis of ocular traumas.

3. Pedagogical objectives: Peculiarities of management of patients with ocular traumas and eyeburns. Methods of rehabilitation at ocular traumas and burns. The reasons leading to ocular traumas. Main clinical symptoms, differential diagnosis, complications of ocular traumas and burns. First aid at electroophthalmia. The symptoms of “sympathetic” ophthalmia

4. Learning outcomes: The student should know: Peculiarities of tactics and management of patients with ocular traumas and eye burns Methods of rehabilitation at ocular traumas and eye burns The reasons leading to ocular traumas and eye burns General clinical symptoms, differential diagnosis, complications of ocular traumas and eye burns First aid at electroophthalmia Symptoms of sympathetic ophthalmia

5. The student should be able to: Determine tactics in patients with ocular traumas and eye burns Perform regular examination and treatment of patients with ocular traumas and eye burns Interpret the results of labs and instrumental methods of examination of patients with ocular traumas and eye burns. Perform consultations of patients with ocular traumas Diagnose of orbital fractures Differentiate different types of eye burns Provide fist aid at eye burns

6. Types of Eye Injury There are a great variety of possible eye injuries but they tend to fit into the following basic types. There are a great variety of possible eye injuries but they tend to fit into the following basic types. Blunt ocular traumas Blunt ocular traumas Penetrating ocular traumas Penetrating ocular traumas Non-penetrating ocular traumas Non-penetrating ocular traumas Chemical eye injuries Chemical eye injuries Minor superficial eye injuries: Minor superficial eye injuries: corneal abrasions corneal abrasions corneal and conjunctival foreign bodies corneal and conjunctival foreign bodies conjunctival lacerations conjunctival lacerations Eyelid injuries Eyelid injuries Orbital injuries and fractures Orbital injuries and fractures Burns of cornea, conjunctiva and eyelid Burns of cornea, conjunctiva and eyelid

7. Distribution % 2 6 10 80 Blunt injuries Burns Non-penetrating eye injuries Penetrating eye injuries

8. Blunt trauma of soft tissues and orbit Injuries are divided by localization: Blunt traumas of soft tissue and orbit Closed fractures of orbit

9. Blunt traumas of soft orbital tissues Signs: - Subconjunctival haemorrage - Haematoma of eyelids - Absence of ocular movements

10. Orbital fractures signs: - diplopy - enoftalm -absence of ocular movements

11. Orbital fractures a) Fractura of medial wall of the eye ( emphyzema of eyelids) b) Fracture of lateral and inferior walls of orbit of right eye с) Fracture of the superior wall of orbit, haematoma of eyelids а b c

12. First-aid tactics First-aid tactics First aid for injuries of surrounding soft tissues: on-site imposition of cold for 1-2 hours (ice, wet wipes). Maintaining hemostatic vasoconstrictors (menadione, vitamin K, Ascorutinum calcium chloride 10%). Immediately send to ophthalmologist.

13. Divided according to severity: Mild - complete recovery Medium - small residual symptoms do not affect visual function Severe - there are large morphological and functional disorders Very severe - Rough morphological changes, loss of function Blunt injuries of eye (contusion)

14. Blunt injuries of the eye Mechanism of eyeball contusion (schematic view)

15. Blunt injuries of the eye Subconjunctival haemorrage Corneal erosion Corneal erosion Hyphaema Hyphaema Haemophthalm (vitreous haemorrhage) Haemophthalm (vitreous haemorrhage) Iridodonezis (trembling of iris) Iridodonezis (trembling of iris) Mydriazis Mydriazis Subluxation of lens Subluxation of lens Iridodializis (detachment or tear of the iris) Iridodializis (detachment or tear of the iris) Choroidal or retinal ruptures Choroidal or retinal ruptures Retinal detachment Retinal detachment Avulsion of an optic nerve Avulsion of an optic nerve Signs: Signs:

16. Choroidal or retinal ruptures Oedema of the cornea and hyphema Oedema of the cornea and hyphema Ruptura of the pupillae Ruptura of the pupillae

17. Blunt injuries of the eye Iridodializis Iridodializis Dislocation of the lens Dislocation of the lens

18. Blunt injuries of the eye Choroidal ruptures and partial haemophthalmos Choroidal ruptures Choroidal ruptures

19. Horoidal or retinal ruptures Retinal detachment Traumatic avulsion of optic nerve

20. Blunt injuries of the eye Blunt injuries of the eye Subconjunctival ruptures of eye

21. First-aid tactics Instillation into the conjunctival sac of antibiotics or sulfa eye drops Anesthesia (local and general) Easy aseptic bandage Immediately send to ophthalmologist

22. Injuries of surrounding tissues Injuries of eyelids Lacrymal ducts injuries Foreign bodies By localization injuries are divided into:

23. Injuries of eyelids Lacerative crush wound of lower eyelid Lacerative crush wound of upper and lower eyelids

24. Lacrymal ducts injuries Laceration of the lower eyelid, with injury of lacrimal duct

25. Foreign bodies of the orbit Wooden foreign body is located in the right orbit and labyrinth (MRI)

26. First-aid tactics Tetanus toxoid Washing the wound with disinfectant solutions Parenteral (i/m) administration of antibiotics Easy aseptic bandage Immediately send to ophthalmologist

27. Wounds of an eyeball Divided by localization: Divided by localization: - Corneal wounds - Scleral wounds - Corneoscleral wounds - By penetrating of external walls - Penetrating injury - Non-penetrating injury - Penetrating injuries are divided into 2: - With intraocular foreign body - With exit of intraocular tissues from the wound

28. Wounds of an eyeball Penetrating injury of cornea, absence of anterior chamber Penetrating injury of cornea, anterior chamber is present

29. Eyeball injuries Penetrating injury of cornea with exit of iris Penetrating corneaal wound complicated with lens opacification

30. Eyeball wounds Penetrating wound of sclera with exit of iris Corneoscleral penetrating injury with foreign body

31. Injuries of an eyeball Borders of cornea are adapted, penetrating wound with foreign body in anterior chamber. Penetrating scleral wound with foreign body.

32. First-aid tactics Tetanus toxoid Tetanus toxoid Washing the wound with disinfectant solutions Parenteral administration of antibiotics Binocular aseptic bandage Immediately send to ophthalmologist

33. Treatment tactics Performed by ophthalmologist in specialized clinics: Performed by ophthalmologist in specialized clinics: - - X-ray of the orbit in the front and lateral projections - - X-ray of orbit by Komberg – Baltin - - Primary surgical treatment of wounds - - Reconstructive operations routinely if necessary.

34. Severe complications after penetrating wounds of the eyeball Endophthalmitis Panophthalmitis Sympathetic ophthalmia Injuries of eyeball

35. Thermic and chemic burns of eyes I (mild) degree - redness and swelling II (average) degree – bubbles III (severe) degree - ischemia and necrotic zone IV (very severe) degree - necrosis Burns of eyelids and conjunctiva are divided by severety

36. I (mild) degree – hyperemia of eye tissues, oedema, superficial corneal erosion. II (medium) degree – deep corneal erosion, oedema, ishchemisation of conjunctiva and limbus area III (severe) degree – in addition to the above mentioned corneal opacification like misted glass in the necrotic zones IV (very severe) degree – porcelain cornea, total necrosis of conjunctiva, perforation Classification by severety: Thermic and chemic burns of eyes

37. Конъюнктива ўрта даражали кимёвий куйиши. Лимб сохасида ишемик қон томирсиз зона. Шох парда ўрта даражали кимёвий куйиши.

38. Thermic and chemic burns of eyes..

39. Кўз олмаси ўта оғир кимёвий куйиши. Асоратли катаракта шох парда яраси Кўз олмаси ўта оғир кимёвий куйиши. Асоратли шишган катаракта, иккиламмчи глаукома.

40. Thermic and chemic burns of eyes Very severe thermic burn

41. Thermic and chemic burns of eyes Very severe thermic burn of eyeball and surrounding tissues

42. Thermic and chemic burns of eyes Very severe thermochemical burns, complicated cataract Severe theromochemical burn of an eyeball. 1 month after the injury.

43. First-aid tactics Removing of burn agent Washing the conjunctival sac during 10-15 minutes. Using buttered solutions Immediately send to ophthalmologist In the hospital: Anesthesia Washing of lacrimal ducts The introduction of autologous blood under the conjunctiva In case of severe burns, tetanus toxoid injection Disinfecting, vitamin solutions Parenteral injection of antibiotics Binocular aseptic bandage

44. Thermic and chemic burns of eyes Енгил ва ўрта даражали куйишларнинг оқибатлари қониқарли Енгил ва ўрта даражали куйишларнинг оқибатлари қониқарли Оғир ва ўта оғир даражали куйишлардан сўнг одатда пластик жаррохликни талаб қиладиган чандиқли ўзгаришлар қолади. Оғир ва ўта оғир даражали куйишлардан сўнг одатда пластик жаррохликни талаб қиладиган чандиқли ўзгаришлар қолади. Оғир ва ўта оғир даражали куйишлардан сўнги асоратланган болаларни кўз патологиясини профилактикаси гурухига киритилади ва узоқ муддат актив диспансер назоратида кузатилади. Оғир ва ўта оғир даражали куйишлардан сўнги асоратланган болаларни кўз патологиясини профилактикаси гурухига киритилади ва узоқ муддат актив диспансер назоратида кузатилади.

45. Acute attack of glaucoma

46. Prophylaxis of ocular traumas Prevention consists of two stages: The first step, i.e. Primary prevention - preventive measures among the population at home, on the streets, in schools, kindergartens. The second stage, i.e. secondary prevention - early diagnosis, urgent measures to actively integrated medical and surgical treatment to help to prevent dangerous complications such as purulent and phacogenic uveitis, metallosis, hypotension eyeball and sympathetic ophthalmia.

47. Questions. 1. Non-penetrating ocular traumas (contusion). Clinical features, diagnosis, treatment. 2. Superficial and deep wounds of eyeball (symptoms, complications, treatment and prevention). 3. Thermal and chemical eye burns (Symptoms, complications, treatment and prevention). 4. Sympathetic inflammation (clinic, prevention, and treatment) 5. Endophthalmitis and panophthalmitis (clinic, prevention and treatment) 6. «X-ray» - the localization of foreign bodies in the eye? 7. Penetrating and non-penetrating traumas of the posterior segment of the eyeball (hospital treatment) 8. Prevention of orbital traumas and the auxiliary apparatus. 9. Electrophthalmia (clinical, prevention, and treatment). 10. Prevention of ocular traumas.