2. Learning Objectives
To be able to identify and evaluate patients with ocular
trauma.
To be able to give primary first aid to the patient before
referral.
To be able to understand the importance of personal
protective equipments and promote awareness about
the same.
PBMA’S H. V. DESAI EYE HOSPITAL
4. EVALUATION
History
General condition
Visual acuity
Complete ocular examination
Assist examination
“Do not forget the Vitals”
Visual acuity.
Pupillary size, shape and reaction to light.
Extra ocular movements.
PBMA’S H. V. DESAI EYE HOSPITAL
5. Eyelid Trauma
Periocular Haematoma
Ecchymosis
Exclude :
-Trauma to globe/orbit
-Orbital roof fracture
( check the post limit of SCH
if noted)
- Basal Skull fracture (
bilateral ring haematomas)
PBMA’S H. V. DESAI EYE HOSPITAL
6. Laceration
Direct closure preferable
Minor lid lacerations not
involving the lid margin or
tarsal plate may be repaired
with nylon (or, in children,
plain gut) 6-0 or 7-0
sutures.
Uncomplicated contusions
are treated with ice packs to
inhibit swelling during the
first 24 to 48 Hrs followed
by hot compresses to aid
absorption of the
hematoma.
PBMA’S H. V. DESAI EYE HOSPITAL
7. ORBITAL TRAUMA- Blow Out Fracture
Sudden increase in orbital
pressure from impacting
object, greater in diameter
than orbital aperture > 5
cm.
Ecchymosis ,edema,s/c
emphysema
Diplopia
Anaesthesia of lower lid
cheek,side of nose, upper
lip,teeth,gums.
Enophthalmos
Exclude intraocular damage
PBMA’S H. V. DESAI EYE HOSPITAL
8. Treatment
Diagnosis best made by CT scan.
If diplopia or cosmetically unacceptable enophthalmos
persists beyond 2 wk, surgical repair is indicated.
Using a topical vasoconstrictor for 2 to 3 days may help
patients with epistaxis.
NOT TO BLOW NOSE.
PBMA’S H. V. DESAI EYE HOSPITAL
9. Orbital Haemorrhage
Retrobulbar haemorrhage-
compressive optic
neuropathy
Proptosis,ecchymosis,
EOM restriction
Decreased V/A
Treatment:
Immediate treatment
Canthotomy f/b
cantholysis at the lateral
canthus.
PBMA’S H. V. DESAI EYE HOSPITAL
18. Effect on vitreous
Detachment
Hemorrhage
Opacities
PBMA’S H. V. DESAI EYE HOSPITAL
19. Effects on
Retina
Pre retinal
haemorrhage
Detachment
Macular
oedema
Macular hole
Pigmentary
degeneration
PBMA’S H. V. DESAI EYE HOSPITAL
20. Effect on optic nerve
Optic nerve
avulsion
Optic nerve
laceration
PBMA’S H. V. DESAI EYE HOSPITAL
21. CHEMICAL INJURY
Acids: acetic, H2SO4, H2S, HCl,
HFl
Alkali- Caustic soda, Lime, Sod.
hydroxide.
Mechanism of action:
Necrosis of surface epithelium &
occlusion of Limbal vasculature.
Deep penetration: precipitation
of glycosoaminoglycans &
stromal cell opacification.
PBMA’S H. V. DESAI EYE HOSPITAL
22. SEQUELE:
Loss of Limbal stem
cells
Vascularization
Epithelial defect
Sterile corneal ulcer
Perforation
PBMA’S H. V. DESAI EYE HOSPITAL
23. Long term effect:-
- Dry Eyes
- Symblepharon
- Cicatrical Entropion
SEVERE
CONSEQUENCES
- AC penetration
- Iris, damage
- Lens damage
- Hypotony
- Phthisis bulbi
PBMA’S H. V. DESAI EYE HOSPITAL
24. MANAGEMENT
To rescue life.
Immediate treatment aims at preventing further injury or vision loss
Never think of the eye in isolation, always compare both eyes
Always record visual acuity as it has medico legal implications
A visual acuity of 6/6 does not exclude a serious eye injury
Beware of the unilateral red eye as it is rarely ‘just’ conjunctivitis
PBMA’S H. V. DESAI EYE HOSPITAL
25. MANAGEMENT
For all eye injuries:
DO NOT touch, rub or apply pressure to the eye.
DO NOT try to remove the object stuck in the eye.
Do not apply any self medication .
See a doctor as soon as possible, preferably an ophthalmologist.
For a chemical burn:
Immediately flush the eye with plenty of clean water.
Seek emergency medical treatment right away.
PBMA’S H. V. DESAI EYE HOSPITAL
26. MANAGEMENT
For a cut or puncture wound:
Gently place a shield over the eye, until medical attention is sought.
DO NOT rinse with water.
DO NOT remove the object stuck in eye.
DO NOT rub or apply pressure to eye.
Avoid aspirin, ibuprofen or other NSAIDS.
See a physician immediately.
PBMA’S H. V. DESAI EYE HOSPITAL
28. TREATMENT
Suturing –
Corneal, Sclerocorneal tear. (the earlier the better)
IOL implantation
Vitrectomy, if needed.
SOS evisceration, fear of sympathetic ophthalmia.
PBMA’S H. V. DESAI EYE HOSPITAL
29. Superficial foreign body
Metallic, wooden
Symptoms:.
watering,
irritation,
pain,
pricking sensation,
congestion.
PBMA’S H. V. DESAI EYE HOSPITAL
30. TREATMENT
Foreign body removal with clean
sterile swab
SOS Desmarre’s retractor , fine
forceps disposable needle.
Under tropical anesthesia & slit lamp
examination.
Locally: Antibiotics,
Lubricants,
Eyepatch for 1 day
PBMA’S H. V. DESAI EYE HOSPITAL
32. MANAGEMENT
MRI avoided
CT Scan to be done
X Rays to bo done
USG to be done
Surgical removal
Removal with magnet
PBMA’S H. V. DESAI EYE HOSPITAL
33. Preventive Measures
Most eye injuries can be prevented with protective or safety
glasses.
Wear safety glasses whenever you operate power tools, such as
drills, saws, or power washers; when using a hammer, or when
mixing or spraying chemicals
PBMA’S H. V. DESAI EYE HOSPITAL
34. Glasses should be:
well-fitted, durable, protective.
Eyewear should be with good
visibility.
There should be strict
compliance on its use.
Need to review the eyewear
design yearly .
PBMA’S H. V. DESAI EYE HOSPITAL
35. Welder's goggles or face
masks should be used
when using an arc welder
Occupational eye safety
programs should be
implemented.
PBMA’S H. V. DESAI EYE HOSPITAL
