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Open Globe Injuries Ayesha S Abdullah 06.12.2013

Open Globe Injuries Ayesha S Abdullah 06.12.2013. Learning Outcomes. By the end of this lecture the students would be able to Diagnose OGI of the eye Describe the complications of OGI Describe the principles of management of OGI

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Open Globe Injuries Ayesha S Abdullah 06.12.2013

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  1. Open Globe Injuries Ayesha S Abdullah06.12.2013

  2. Learning Outcomes By the end of this lecture the students would be able to • Diagnose OGI of the eye • Describe the complications of OGI • Describe the principles of management of OGI • Recommend measure for the primary, secondary and tertiary prevention of OGI

  3. A 15 year old boy was hit in the eye with a cricket ball which of the following would the most likely complication • Choroidal Tear • Hyphaemia • Macular Hole • Optic Nerve Avulsion • Scleral Rupture

  4. A 30 year old lady presents with the complaint of splashing of some chemical into her right eye while cleaning the toilet, what would be the most appropriate first line of management • Ascertain the degree of limbal ischemia • Perform a vigilant examination • Refer to an ophthalmologist • Take a detailed history • Wash the eye with copious amount of water

  5. OGI of the eye-Diagnosis • History • Clinical examination • Investigations

  6. Management 1. Proceed with caution2. Assess the total patient first: Make sure there is no life threatening injury and the patient is hemodynamically stable before proceeding with your exam.  3. Make the patient comfortable 4. Assess visual acuity and pupils 5. Assess the adenexalstructures6. Visualize the globe …………………………………………………………………………AAO

  7. Management 7. Evaluate the fellow eye 8. Use additional testing and imaging modalities 9. Refer for the repair10. Talk with patient and family.

  8. OGI with Intraocular Foreign Bodies (IOFB) • May damage the eye • Mechanically • Introducing infection • Causing severe inflammation • Toxic effects • Location of foreign bodies • Cornea • Anterior Chamber / Iris • Lens • Posterior Segment • Orbital

  9. Types of foreign bodies • Inert • Glass • Stone • Gold • Organic • Plant • Animal • Metallic • Iron - Siderosis • Copper- Chalcosis

  10. OGI with I.O.F.B- Summary • Suspected in any ocular/orbital trauma. • Detailed Hx is important. • X-Rays(frontal/lateral)…..for presence • C.T…..for location. • MRI…..contraindicated(for metallic) • Electrophysiological test to assess integrity of optic nerve and retina • Infection (endophthalmitis/ panophthalmitis) Structural and functional damage and are the biggest threats

  11. Siderosisbulbi

  12. Sympathetic Ophthalmitis

  13. Definition “Sympathetic Ophthalmitis is a very rare , bilateral,diffusegranulomatouspanuveitis which occurs after penetrating ocular trauma, that is usually associated with uvealprolapse or rarely following intraocular surgery.”

  14. Sympathetic Ophthalmitis • Trauma to Ciliary body and retina • Retinal S-antigen • Exciting eye (the injured eye) • Sympathizing eye ( the normal/uninjured eye) • Chronic granulomatpusinflammation • Sympathizing Eye also develops uveitis

  15. Clinical presentation • Mostly (65-80% of the cases ) sympathetic uveitis develop between 2 weeks & 3 months after initial injury. • 90% of all cases occur within the first year. • Anterior Segment: • The Exciting eye -- evidence of initial trauma, excessively red & irritable, signs of granulomatousuveitis • Sympathizing eye -- irritable, photophobia • then bilateral granulomatous anterior uveitis with iris nodules & mutton fat KPs • Posterior Segment: • Optic Disc swelling & multifocal choroiditis • mostly the process becomes chronic & may be complicated by cataract, glaucoma & phthisis bulbi

  16. Treatment • Topical & Systemic Steroids • Immunosuppressive therapy in steroid-resistant cases(Cyclosporin) • Enucleation of the injured eye, if performed within 7-10 days of the injury prevents sympathetic ophthalmitis. Enucleation of the exciting eye is of no benefit once the fellow eye becomes inflammed

  17. Thermal Burns Usually caused by • Flames • Hot splashes • Direct contact of hot metals • Usually limited to the lids and the cornea Management • Relive pain • Prevent secondary infection of cornea from exposure • Minimize Eye lid scarring • Limited debridement Macular burn by solar eclipse

  18. Ultra-violet Radiation Injury Caused by Welding arcs Snow blindness Involves cornea, very painful Heals within 24 hours Management Relive pain,cycloplegic agent, antibiotic eye drops / ointment Patch the eye

  19. Test • Refractive errors • Strabismus • Amblyopia • Uveitis • Ocular injuries 15 MCQs+ 5 Marks for the HW assignment Total 20 marks

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