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Flashcards in Eye injury Deck (18)
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1
Q

What are the main types of eye trauma?

A
  • Corneal abrasions
  • Foreign bodies
  • Radiation damage
  • Chemical damage
  • Blunt injuries with hyphaema
  • Penetrating injuries
2
Q

What are features of a blunt force trauma to the eye?

A
  • Lid injury
  • Orbital blow-out fracture
  • Corneal abrasion
  • Anterior hyphema
  • Traumatic mydriasis
  • Lens dislocation
  • Vitreous hemorrhage
  • Retinal detachment
  • Traumatic iritis
  • Ruptured globe
3
Q

When taking a history of a blunt eye injury, what would you want to ask about?

A
  • Symptoms — visual disturbance or loss of vision, pain at rest or on movement, and diplopia.
  • Mechanism of injury — any suspicion of penetrating eye trauma requires prompt assessment, so that urgent referral can be made.
  • Type of projectile and velocity — small high-velocity projectiles are at higher risk of penetrating injury.
  • Use of eye protection
  • Associated injuries
4
Q

What investigations would you do for blunt eye trauma?

A
  • Consider CT or XR of the orbits if an orbital wall fracture is suspected.
  • CT head/ neck if coexistent head and neck injuries need to be ruled out.
5
Q

How would you manage blunt trauma to the eye?

A

Refer to opthalmology

  • Bed rest
  • Head elevation
  • Analgesia
  • Topical steroids - G. Predforte
  • Topical cycloplegics - Atropine
  • Topical IOP lowering - if needed
6
Q

What signs might suggest a blowout fracture or the orbit in a blunt eye injury?

A

Decreased sensation of the lower eyelid - infra-orbital nerve injury

7
Q

What injuries resulting from eye trauma usually require immediate consultation with an ophthalmologist?

A
  • Chemical burns of the eye
  • Perforation of the globe or cornea
  • Lens dislocation
  • Orbital hemorrhage with increased IOP
  • Lacerations - lid margin, tarsal plate or nasolacrimal drainage system
  • Optic nerve injury
8
Q

What traumatic eye injuries do not usually require immediate assessment by an ophthalmologist, but should be followed up within ~24 hour?

A
  • Anterior hyphema
  • Blow-out fracture
  • Retinal injuries
9
Q

What are features of penetrating eye trauma?

A
  • Corneal or Corneal Laceration
  • Severe conjunctival chemosis and haemorrhage
  • Ocular hypotony
  • Shallow anterior chamber
  • Irregular pupils
  • Extrusion of intraocular contents
  • Limited extraocular movements
10
Q

What are complications of penetrating eye injury?

A
  • Permanent loss of vision — enucleation may be necessary
  • Corneal ulcers — may lead to delayed perforation.
  • Infection — e.g. endophthalmitis
  • Sympathetic ophthalmia — enucleation of the severely traumatised eye should be performed initially or within 1-2 weeks to prevent this in the severely damaged eye
11
Q

What is the management of a penetrating eye injury?

A

STOP EXAMINATION an Immediate opthalmological referral

  • Apply eye shield (NO PATCH) on affected eye
  • Consider pathcing padding unaffected eye - prevent conjugate movement
  • Tetanus prophylaxis
  • Systemic antibiotics
  • NBM
  • X-ray/CT Orbit
12
Q

What aspects of the history may suggest a penetrating eye trauma?

A

Working with flying objects - e.g. hammer, lathes, chisels

13
Q

What type of chemical burns are more dangerous; acid or alkali?

A

Alkali - tend to penetrate cornea faster and rapidly damage intraocular contents

14
Q

What effect do acids have on the eyes?

A

Tend to coagulate corneal proteins - this stops penetration

15
Q

How would you manage someone with chemical burns to the eyes?

A

Stabilise

  • Immediate copious irrigation with 1-2 litres of Saline
  • Topical anaesthetic
  • Double eversion of eyelids - thorough cleansing

Once stabilised

  • Topical antibiotics
  • Lubricants
  • Cycloplegics
  • Vitamin C
  • Steroids

REFER TO OPTHALMOLOGIST

16
Q

What features can be seen in an injured eye?

A

Always refer

  • Abnormal eye movements
  • Basal tear of iris
  • Hyphaema
  • Marginal laceration

Other

  • Foreign body
  • Distorted pupil
  • Subconjunctival haemorrhage
  • Epithelial loss
17
Q

How would you remove a foreign body from the eye?

A
  • Use local anaesthetic
  • If the foreign body is loose, irrigate the eye
  • If the foreign body is adherent, use a cotton wool bud or the edge of a piece of cardboard
18
Q

What are features of an orbital blowout fracture?

A
  • Diplopia
  • Recessed eye
  • Reduced vertical gaze
  • Subconjunctival haemorrhage
  • Swollen lid
  • Ipsilateral nose bleed
  • Loss of sensation