Ocular injuries- An introduction & nomenclature 22.11.2013

1. Ocular injuries- An introduction & nomenclature22.11.2013 Ayesha S Abdullah

2. Learning outcomes By the end of this lecture the students would be able to • Describe the epidemiology of ocular injuries • Classify globe injuries according to the Birmingham Eye Trauma Terminology (BETT) system of classification • Differentiate between OGI and CGI

3. How common is it? • Trauma is the commonest cause of ocular emergencies reported in trauma centres • A total of 1.6 million cases of blindness are caused by eye injures • Some 2.3 million cases with low vision are due to ocular injuries • Some 19 million cases of mono ocular blindness are due to eye injuries

4. Risk factors • Gender , any guess? • 3:1 male to female ratio • Rural areas • Compromised socioeconomic status • Illiteracy • Conflicts

5. Classification • According to vector (The Agent) • According to settings (Place of injury) • According to pathology (Effects produced) • According to anatomical structures involved • According to severity (Damage produced)

6. According to the site involved • Orbital trauma • Superficial & corneal foreign bodies • Lid injuries • Globe injuries

7. Nature of injurious agent • Mechanical Injuries • Chemical Injuries Acid Alkali Others • Radiation Injuries • Thermal Injuries • Electrical Injuries

8. Place of Injury • Home • School • Playground • Agriculture • Industry • Laboratory • Workshops • Assault/ combat

12. Birmingham Eye Trauma Terminology System (BETTS) Trauma to the Globe http://www.asotonline.org/bett.html

13. Definitions -BETTS • Closed Injury in which cornea & sclera are intact but there is intraocular damage. • Open Injury is associated with full-thickness wound of cornea or sclera or both. • Rupture is a full-thickness wound caused by blunt trauma • Laceration is full-thickness injury caused by a sharp object • Penetration is caused by a single laceration with a sharp object • Perforation consists of two lacerations, one entry and one exit http://www.asotonline.org/bett.html http://bestpractice.bmj.com/best-practice/monograph/961/basics/classification.html

19. Orbital trauma • Blow out floor fracture, medial wall, floor, roof • Contusion injury • Lacerations • Orbital haematoma

20. Eye Lids • Contusion • Hematoma • Lacerations

21. Beware of the blood loss especially in children

22. Late Complications

23. Effects of close globe injury (CGI) • Mechanism • AP compression • Expansion in the equatorial plan • Transient & excessive increase in IOP • Impact is primarily absorbed by ?? • Lens –Iris diaphragm & vitreous • The damage can happen in any tissue • commonly has long-term effects/ sequelae

26. Close Globe Injuries • SubconjunctivalHaemorrhage • Corneal abrasion • Acute corneal oedema • Traumatic iritis • Traumatic Mydriasis / Miosis • Hyphaema • Iridodialysis • Cyclodialysis / Angle recession • Ciliary shock

27. Close Globe Injuries • Subluxation and dislocation of lens • Cataract • Posterior vitreous detachemet • Vitreous haemorrhage • Choroidal rupture • Commotioretinae • Retinal Breaks • Dialysis • Equatorial tears • Macular holes • Optic nerve avulsion

33. Home work List three recommendations for the following • Primary • Secondary • Tertiary prevention of ocular trauma Three power point slides with three points on each slide send at msqheartline@hotmail.com with your name and role number