Scribd
Upload
123 views68 pages

Eye Trauma: Penetrating and Blunt

Blunt and penetrating eye injuries can cause a variety of injuries from minor abrasions to potentially sight-threatening conditions. Blunt injuries commonly cause contusions, hemorrhages, and corneal abrasions while penetrating injuries may lead to embedded foreign bodies. Immediate referral is needed for loss of vision, irregular pupils, hyphema, penetrating injuries or suspected globe rupture. Sports involve varying risks of eye trauma, from low risk such as swimming to very high risk like boxing.

Uploaded by

Surgicalgown
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPT, PDF, TXT or read online on Scribd
123 views68 pages

Eye Trauma: Penetrating and Blunt

Blunt and penetrating eye injuries can cause a variety of injuries from minor abrasions to potentially sight-threatening conditions. Blunt injuries commonly cause contusions, hemorrhages, and corneal abrasions while penetrating injuries may lead to embedded foreign bodies. Immediate referral is needed for loss of vision, irregular pupils, hyphema, penetrating injuries or suspected globe rupture. Sports involve varying risks of eye trauma, from low risk such as swimming to very high risk like boxing.

Uploaded by

Surgicalgown
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPT, PDF, TXT or read online on Scribd
You are on page 1/ 68

Eye trauma: Penetrating and

blunt
Adapted from source
Anatomy
Blunt eye injuries

• contusions
• subconjunctival haemorrhages
• corneal foreign bodies &
abrasions
• hyphaema
• burns
• blow-out fractures
• retrobulbar haemorrhages
• other
Sport classification and risk
• Collision
football, rugby, hockey

• Contact
wrestling

• Non-contact
track, tennis, rowing, swimming, x-country running

• Other
bowls, golf, archery, field events
Risk cont …
• Low risk
= no use of ball, bat, puck, stick, racquet AND no
body contact
track, field, swimming, gymnastics, cycling

• High risk
baseball, raquet sports, golf, water polo, fencing

• Very high risk


boxing, wrestling, contact martial arts
The big five for red eye:
1. subconjunctival haemorrhage

2. corneal foreign bodies

3. corneal abrasions

4. hyphaema

5. uveitis
Sub Galeal Haematoma
chemosis
subconjunctival haemorrhage
corneal
foreign body
corneal abrasion
fluorescein
WARNING !

topical

X
anaesthetics

TTO
Chemical burns
Assault
periorbital haematoma
proptosis
retrobulbar haemorrhage
surgical empyhsema
Blowout fractures
hyphaema
uveitis
posterior synechiae
Dilate
iridodialysis
avulsed optic nerve
optic atrophy
macular hole
commotio retinae
retinal detachment
choroidal tear
What are signs/symptoms of
trauma that would require
immediate referral?
What are signs/symptoms of trauma that
would require immediate referral?

• Loss of vision or visual field


• Diplopia /Proptosis of the eye
• Light flashes or floaters
• Irregularly shaped pupil
• Red/inflamed eye /FB sensation/embedded foreign body
• Hyphema (blood in anterior chamber)
• Halos around lights (corneal edema)
• Laceration of the lid margin or near medial canthus
• Broken contact lens or shattered eyeglasses –glass in eye
• Suspected globe perforation
Trauma: Blunt or penetrating?
• Structures involved
• Examination of eye
• Penetrating ? IOFB
• When to refer
3-D Anatomy
Penetrating wounds: History helpful
IOFB
Subconjunctival haemorrhages
Penetrating
Lid margin laceration
Carefully align to prevent notching

Align with 6-0 black silk Close tarsal plate with


suture fine absorbable suture

Place additional marginal Close skin with multiple


silk sutures interrupted 6-0 black
silk sutures
Canalicular laceration

• Repair within 24 hours • Locate and approximate ends of laceration


• Bridge defect with silicone tubing
• Leave in situ for about 3 months
Points on the eyelids
• Refer if lid edge is involved – Ophthalmic or
Plastics
• Orbicularis oculi muscle is supplied by the VIIth
cranial nerve and closes the eye
• The levator muscle opens the lid (IIIrd nerve)
• Blink reflex
– Afferent is often Vth nerve
– Efferent is VIIth nerve
The anterior chamber

• May contain blood (hyphaema) after trauma

• May contain pus (hypopyon) in infections of the eye


Checking for penetrating injury
What are important
clues to penetration of
the eye?
Checking for penetrating injury

 Soft eye
 Visual acuity ↓
 Red reflex absent
Corneal and scleral lacerations
Management of intraocular foreign bodies

X ray
CT Scan
B-scan Ultrasound

Localization with reference to radio-


opaque marker
Removing IOFB’s

Modern – Forceps
and vitrectomy
Old – Electro-magnet
Complications of penetrating trauma

Flat anterior chamber Uveal prolapse Damage to lens and iris

Vitreous haemorrhage Tractional retinal detachment Endophthalmitis


Endophthalmitis
Endophthalmitis
• Replicating organisms inside the
eyeball
• Often: Staphylococci, Bacillus or
Gram negative bacteria
• Pain, red eye, hypopyon, loss of vision
and red reflex

You might also like