1. Ocular Trauma Sandra M. Brown, MD1 and Yair Morad, MD2 1 Ophthalmology and Visual Sciences Texas Tech University Health Sciences Center Lubbock, Texas USA 2 Pediatric Ophthalmology Service, Assaf Harofeh Medical Center, Zrifin, Israel

2. Nature of Injury • Blunt • Lacerating • Chemical

3. Blunt Trauma • Mild – moderate • “Bruise” ocular tissues • Eye wall intact • Moderate – severe • Rupture eye wall • Very severe consequences

4. Lacerating Trauma • “Cut” eye wall • Outcome depends on extent and location

5. Location of Injury • Anterior segment • Posterior segment • Adnexa • Orbital structures

6. Anterior Segment • Conjunctiva • Cornea • Iris • Lens

7. Posterior Segment • Vitreous • Retina • Optic nerve

8. Adnexa • Eyelids • Lacrimal Structures

9. Orbital Structures • Extraocular muscles • Bony walls

10. Disgusting Photographs • Front to back…

11. Racoon Eye • Self limiting if no other injury exists • No treatment needed • Be sure to open lids apart to examine the eye structure and motility

12. Lid Laceration

13. Lacrimal Duct Laceration • Repair ASAP • Probing with silicon tube and suturing

14. Conjunctival Trauma • Sub conjunctival hemorrhage • Self limiting • No treatment needed • Conjunctival laceration • Make sure the sclera is intact • Antibiotic ointment for 1-3 days

15. Subconjunctival Hemorrhage

17. External Foreign Body • Can be in conjunctiva or cornea • Red painful and watery eye • Removal under slit lamp • Patching with antb

18. Corneal Foreign Body

20. Corneal Abrasion • Severe pain and photophobia • Blurry vision • Erosion stains with fluresceine • Patching with antibiotic oint to prevent infection and help re- epithelization • Healing 1-4 days

21. Corneal Abrasion

22. Chemical Burn • Usually fat-cleaning materials • Pain, photophobia • Treatment: irrigation, irrigation, irrigation

23. Corneal Penetration • Minor wound can be self sealing and leave the eye intact • Patient complains on photophobia and pain • Only on slit lamp examination perforation is diagnosed

24. Corneal Perforation -Cont • Iris can be captured in the perforation wound • Iris reposition if soon after the injury and corneal suturing

26. Hyphema • Blood in anterior chamber • Sometimes hard to diagnose • Blurry vision and pain • Self limiting • Complications: elevation of intra-ocular pressure and re-bleeding

27. Traumatic Cataract • Usually repaired in a secondary operation • If possible a plastic intra-ocular lens is inserted instead of the damaged lens • Treatment of amblyopia crucial

28. Traumatic Cataract

29. Vitreous Hemorrhage • Blood in vitreous cavity • Usually self limiting • Can be cleared with vitrectomy is rare occasions

30. Retinal Hemorrhage

31. Optic Disc Hemorrhage

32. Intra-ocular Foreign Body • Ocular emergency • Removal in vitrectomy • Retained FB can cause infection or retinal degeneration

33. Orbital Wall Fracture • Problematic only if: • Limitation of eye ductions • Disfiguring enophthalmos

34. Traumatic Optic Neuropathy • Optic nerve injured in optic canal • Usually vision loss • No good treatment • Mega-dose steroids?

35. Common Minor Eye Injuries • Corneal abrasion • Corneal foreign body • Chemical splash • Traumatic iritis

36. Diagnosis • History • Sharp vs blunt vs chemical injury • Exam • CHECK VISION • CHECK VISION • CHECK VISION

37. Diagnosis cont. • Exam – open lids apart! • Cornea clear? • Pupil round? • Pupil black? • Blood clotted behind cornea?

38. Diagnosis cont. • Exam • Red reflex? • Eyes move symmetrically?

39. Fluorescein Test • Topical “eye dye” • COBALT light

40. Corneal Abrasion

41. Abrasion Treatment • Antibiotic ointment • +/- patch • 1-2 day follow-up with eye doc

42. Corneal Foreign Body

43. Foreign Body Treatment • Anesthetize eye • Remove FB • Cotton swab (don’t worsen abrasion!) • Kimura spatula • +/- needle tip • Antibiotic oint +/- patch • 1-2 day follow-up with eye doc

44. Chemical Treatment • IRRIGATE with large amounts of water • Check PH • Minor • Antibiotic ointment • 1 day follow-up eye doc • Major • Same day evaluation by eye doc

45. Traumatic Iritis • Moderate blunt injury • Photophobia • Lid bruising/edema • Subconjunctival hemorrhage or injection • Pupil sluggish • Evaluation by eye doc

46. Please Do Not Confuse • Subconjunctival hemorrhage • Hyphema