2. What is ocular trauma?
Damage or trauma inflicted to the eye
by external means.
The concept includes both surface
injuries and intraocular injuries.
During trauma soft tissues and bony
structures around the eye maybe
involved.
3. Epidemiology
• Ocular trauma is the cause of blindness in
about half a million people worldwide.
• Trauma is the most important cause of
unilateral loss of vision, particularly in
developing countries.
4. • 90% are preventable
• >50% of the total injuries occur in patients less
than 25 yrs of age
and 34% of them in pediatric group.
10. • Eyewall : It consists of the Sclera and the Cornea
• Closed globe injury :
No full-thickness wound of eyewall, but there is intra-
ocular damage.
• Open globe injury:
It refers to the full thickness injury of the eye wall and the
intra-ocular structures.
• Contusion:
It is a result of direct energy delivary to the eye by a blunt
object. injury may be at the site of impact or at a distant
sitte
11. • Lamellar laceration:
Partial-thickness wound of the eyewall.
• Laceration : Full-thickness wound of the eyewall,
caused by a sharp object.
• Penetrating injury:
is an injury where a foriegn object has been
embedded in the eye .It is usually a full thickness
wound & it has a site of Entrance.
• Perforating injury :
has both an Entrance and exit wounds. Both
wounds caused by the same agent.
12. Penetrating injury
• Trauma is Usually by a
sharp and pointed
instruments like
needles, sticks, pencils,
knives, arows, pens,
glass and any object
with sharp edges.
16. Children, mostly sustain accidental injuries by
rubber bands, needles, pencils, sticks while
playing with others.
17. Effects of Penetrating ocular injuries
• Mechanical effect such as Laceration of the
conjunctiva & corneal, Vitreous haemorrage,
rupture of globe ,retinal tears and
detachments, scarring which leads to cataract
and glaucoma. And Intra ocular foriegn
bodies.
18. • Introduction of infection:
the entrance of the wound may serve as a
route of entry for pyogenic bacteria,which
may lead to the fromation of abscess of
cornea, purulent iridocyclitis or
Endophthalmitis
20. Main symptoms
• Redness of eye,
• Haemorrages
• Congestion
• Lacrimation
• Photophobia
• Itchy/Watery Eyes
• Blurring or Loss of Vision
• Change in Pupil Shape
• Blood or Fluid Leakage from the Eye
• Foreign Object Penetrating Eye
21. Don’ts and do’s
DO NOT flush the eye with any liquids other than saline
or warm water or
even better just do not touch the eye
22. • DO NOT remove the object out of the eye
• DO NOT put any pressure on the eye
24. What to do ?
> Flush the eye with copious amounts of saline or warm
water until symptoms resolve unless severe, penetrating
or bleeding injury.
> Reassure the person and advise against rubbing or
moving their eye as this can cause further damage
25. If the injury is severe, place a moist pad and
loosely bandage the eye.
Transport the patient to the nearest Hospital as
fast as possible
26. In the case of small penetrating objects,
use a cup to cover the object and keep the
person calm and lying down until help
arrives.
27. Common diagnostic procedures for
ocular injuries
• External examination of the eye
• Measurement of intra ocular pressure using
tonometer
• Direct ophthalmoscopy:
• Indirect ophthalmoscopy:
• Slit-lamp examination:
• Visual acuity test
• Ultrasound :
• Electroretinogram :
29. • A corneal laceration is a partial- or full-
thickness injury to the cornea,
• caused by flying metal fragments, sharp
objects, fingernails, air-bag deployment,
fireworks, explosions, blunt force trauma,
pellets.
• History of the patient sometimes points to a
discrete event after which the patient’s
symptoms started.
30. • The main symptoms are
• intense pain initially which diminish slightly due to
corneal desensitization.
• Patients are photophobic and lacrimate profusely.
• There is a significant uveitis and the anterior
chamber is shallow or even flat in a full thickness
laceration.
• Intraocular pressure generally ranges from 2 to 6
mmHg.
• Bubbles within the anterior chamber are a key
finding.
• There is significantly reduced visual acuity
31. Treatment
• Perform an examination to ascertain the extent of the
corneal, anterior chamber, ocular injury.
• Administer systemic analgesic for pain,
• If the laceration is <2mm
• Use systemic analgesics and antibiotics.
• Topical anesthetics may be used, if needed, to facilitate visual
activity testing and the slit lamp examination.
• combination of a cephalosporin (eg, cefazolin) or vancomycin
and an aminoglycoside (eg, gentamicin). This is used o achieve
broad-spectrum coverage.
• Antibiotics are used in prophylaxis of endophthalmitis
• If the laceration is >2mm the wound is sutured.
33. • Clinical features:
• May be isolated or part of more severe
intraocular injuries.
• Symptoms: ocular irritation, pain and foreign
body sensation.
• Signs include chemosis, subconjunctival
hemorrhage and torn conjunctiva.
34. • Work up:
• Thorough eye examination under topical or
general anesthesia includes dilated fundus
examination to rule out intraocular foreign
body.
• Seidel test to rule out open globe injury.
• Ultrasonography.
• CT scan to rule out intraocular foreign body.
35. • Management:
• Observation.
• Prophylactic topical antibiotics for small
lacerations.
• Surgical repair(suturing) may be required for
large lacerations >2mm
36. Globe Rupture
Operating microscope view of a globe rupture secondary to blunt trauma by a
fist. Notice the dark arc in the bottom of the photo representing the ciliary body
visible through the scleral breach. Subconjunctival hemorrhage of this severity
should raise suspicion of occult globe rupture
37. • Globe rupture may occur when a blunt object
impacts the orbit,
• Ruptures from blunt/penetrating trauma usually
occur at the sites where the sclera is thinnest,
• Sharp objects or those traveling at high velocity may
penetrate the globe directly.
• Small foreign bodies may penetrate the eye and
remain within the globe.
• The possibility of globe rupture should be considered
and ruled out during the evaluation of all blunt and
penetrating orbital traumas as well as in all cases
involving high-speed projectiles with potential for
ocular penetration.
38. • Globe rupture in adults may occur after
blunt/penetrating injuries during motor vehicle
accidents, sports activity, assault, or other trauma.
• may occur with gunshot and stab wounds, workplace
accidents, and other accidents involving sharps or
projectiles.
• Shoul Be particularly suspicious of eye injuries
caused by metal striking metal (eg, hammer and
chisel).
• One third of eye injuries occurring in children and
adolescents are sports related.
39. • Symptoms
• Pain
Pain may be difficult to assess in patients with distracting
injuries.
Pain may not be severe initially in sharp injuries, with or
without intraocular foreign body.
• Vision - Usually greatly decreased
• Diplopia
If present, diplopia is usually due to entrapment and
dysfunction of extraocular muscles with associated orbital
floor blowout fractures.
Diplopia may be due to traumatic cranial nerve palsy from
associated head injury.
Monocular diplopia may be due to associated lens dislocation
or subluxation.
40. Work up
• Physical examination
Globe rupture may be immediately apparent on
examination but is frequently occult, as the most
frequent sites of rupture are not easily visualized and
more superficial injuries may block examination of the
posterior segment.
Examination of the injured eye should proceed
systematically but always with the goal of identifying
and protecting a ruptured globe.
It is critical to avoid putting pressure on a ruptured
globe to minimize potential extrusion of intraocular
contents and to avoid further damage.
41. Visual acuity and eye movement
Visual acuity should be documented
as accurately as possible for the injured
and uninjured eye, even if it is limited to
"counts fingers at 18 inches" or "light
perception only.”
42. Orbit
• Orbits should be examined for bony deformity,
foreign body, and globe displacement.
• Orbital foreign bodies that may have impaled or
perforated the globe should be left undisturbed
until surgery.
• A ruptured globe may present with
enophthalmos.
• An associated retrobulbar hemorrhage may cause
exophthalmos, even with an occult scleral
rupture.
43. Eyelid
Eyelid and lacrimal injuries should be
evaluated with the major goal of identifying
and protecting possible deep injuries to the
globe.
Lid repairs should not proceed until globe
injury is ruled out.
44. • Conjunctival lacerations may overlie more
serious scleral injuries.
• Severe conjunctival hemorrhage (often
covering 360 degrees of bulbar conjunctiva)
may indicate globe rupture.
45. Cornea and sclera
A full-thickness laceration to the cornea or sclera
constitutes a globe perforation, and it should be
repaired in the operating room.
Prolapse of the iris through a full-thickness corneal
laceration may be visible as a dark discoloration at the
site of injury.
46. • Intraocular pressure will likely be low, but
measurement is contraindicated to avoid
pressure on the globe.
47. AC
• A shallow anterior chamber may be the only
sign of occult globe rupture and is associated
with a worse prognosis.
• A posterior rupture may present with a
deeper anterior chamber due to extrusion of
vitreous from the posterior segment.
48. PUPIL
Pupils should be examined for shape, size,
light reflex,
A peaked, teardrop-shaped, or otherwise
irregular pupil may indicate globe rupture.
49. • Vitreous hemorrhage after trauma suggests
retinal or choroidal tear, optic nerve avulsion,
or foreign body.
50. Treatment
• Pre-hospital Care
A suspected or obvious ruptured globe should be protected from any
pressure or inadvertent contact with a rigid shield during transport.
Impaled foreign bodies should be left undisturbed.
51. Emergency Department Care
• Avoid all pressure on or around the injured eye
to prevent extrusion of intraocular contents.
Continue to protect the eye with a rigid
shield. If a shield is not available, the bottom
of a cup works well.
• Administer analgesics as indicated.
• Administer prophylactic antibiotics,
Ideally within 6 hours of the injury, to prevent
endophthalmitis.
52. • Prophylactic systemic antibiotics are indicated in all
cases of globe rupture.
• The risk of post-traumatic endophthalmitis is
greatest when a penetrating injury exists, particularly
with a retained intraorbital foreign body.
• Skin flora are the most common organisms, but
contamination with soil, farm or animal flora, human
saliva, or nonsterile water may introduce gram-
negative organisms, anaerobes, and fungi.
• Cefazolin and Ciprofloxacin
53. Retinal detachment
• Rhegmatogenous retinal detachment –
A rhegmatogenous retinal detachment occurs due to a hole, tear, or break
in the retina that allows fluid to pass from the vitreous space into the
subretinal space between the sensory retina and the retinal pigment
epithelium.
• Exudative, serous, or secondary retinal detachment –
An exudative retinal detachment occurs due to inflammation, injury or
vascular abnormalities that results in fluid accumulating underneath the
retina without the presence of a hole, tear, or break.
• Tractional retinal detachment –
A tractional retinal detachment occurs when fibrovascular tissue, caused
by an injury, inflammation or neovascularization, pulls the sensory retina
from the retinal pigment epithelium.
54. • CF
• flashes of light (photopsia) – very brief in the
extreme peripheral part of vision.
• a sudden dramatic increase in the number of
floaters
• If the patient experiences a shadow or curtain
that affects any part of the vision, this can
indicate that a retinal tear has progressed to a
detached retina
• a slight feeling of heaviness in the eye
• Gradual loss of vision
55. Treatment
• Surgery is the only effective therapy for a retinal tear, hole
or detachment
• If a tear or a hole is treated before detachment develops
or macula detaches, we can probably retain much of your
vision.
56. • Laser surgery
(photocoagulation).
The laser makes burns
around the retinal tear, and
the scarring that results
usually "welds" the retina
to the underlying tissue.
• Freezing (cryopexy).
This freezes the area
around the hole, leaving a
delicate scar that helps
secure the retina to the eye
wall.
58. Intra ocular foreign bodies(IOFB)
• The seriousness of the injury depends upon the
retention of the intraocular foreign body
• Common foreign bodies maybe chips of iron or steel,
particles of glass, stone, lead pellets, wood chips,
plastic
59. • The symptoms of a foreign body may range from irritation to
intense, excruciating pain. This is dependent on the location,
material, and type of injury.
• Mild to extreme irritation
• Scratching
• Burning
• Soreness
• Intense pain
• Redness
• Tearing
• Light sensitivity
• Decreased vision
• Difficulty opening the eye
60. • Anterior chamber:
the IOFB usually sinks to the bottom and may be concealed at the angle of
the anterior chamber.It is usually seen using a gonioscope.
• Treatment:
A corneal incision is made directed towards the
foreign body. it is usually made 3mm internal to
the limbus and in the quadrant of the cornea
lying over it.
Magnetic IOFB is removed using a magnet.
Non magnetic IOFb are removed using a needle
or forceps.
61. Foreign body entangled in the iris tissue
(magnetic and non magnetic) is removed By
performing sector iridectomy of the part
Containing the FB.
62. • Foreign body in lens: An extra capsular
cataract extraction with intra ocular lens
implantation should be performed.The foreign
body should be removed along with the lens
or maybe removed with the help of forceps
63. Foreign body in vitreous
• Magnetic removal :
This technique is used to remove magnetic foreign bodies
that can be well localized and removed using a powerful
magnet without causing much intra ocular damage.
Intravitreal foreign body is removed using pars plana
sclerotomy. An incision is made 5mm from the limbus, a
preplaced suture is made and the lips of the wound are
retracted, using a powerful hand held electro magnet the
foreign object is removed,and the incision is sutured .
64. Intra retinal foreign body
The site of incision is made as close to the FB as
possible. A scleral flap is created,the choroid is
incised and the FB is removed using forceps.
Non Magnetic Foreign bodies: Pars Plana
viterectomy is usually performed. In this
method the FB is removed using a vitreous
forceps after performing a 3 pore pars plana
viterectomy under direct visualization using an
operating microscope.
