Download Ocular and Orbital Trauma

Ocular and Orbital Trauma
Jasmin Jiji B. Miranda
ASMPH LEC Group 8
Ophthalmology Clerkship Rotation: QMMC
References
 Vaughan & Asbury’s General Ophthalmology 17th
ed.
 ASMPH Ophthalmology Lecture Notes on
“Ocular and Orbital Injuries/Emergencies” by
Dr. Nonette Pasco-Rosete. January 2010.
 www.opthobook.com
Outline
 Initial Examination of Eye Trauma
 ER Management
 Lid Lacerations
 Foreign Bodies
 Corneal Lacerations/Abrasions
 Penetrating Injuries and Contusions of the Eyeball
o Globe Rupture
 Burns of the Eye
 Orbital Fractures
3-DAY OPHTHALMOLOGY OPD (SERVICE) CLERKS' CENSUS
N = 62
Initial Examination
 HISTORY
o mechanism of injury
• abrasion, blunt force, penetrating object, burns
o symptoms
o time of the injury
o visual acuity prior to the injury
Initial Examination
 PE:
o Visual acuity
o Eye examination
o Including uninjured eye
o Photodocumentation for medicolegal purposes
 Labs and imaging
ER Management
 Stabilize patient
 Obtain history
 Address eye injury
 Avoid unnecessary manipulation
o Use medications with caution
 Chemical burns: IRRIGATE
 Check pH: 7.0 to 7.4
Lid Laceration
PLAN
 Primary repair + Antibiotics + Analgesics
 Canalicular injury: silicone nasocanalicular intubation
Foreign Bodies
Inert: glass, rubber,
stone
Inflammatory: Iron,
steel, organic material
PLAN
 Removal of foreign body
 Surgical intervention
 Infection coverage + eye patch
Corneal Lacerations/Abrasions
Positive Seidel Test
PLAN
 Antibiotic coverage
 Artificial tears
 Cyclopegics
 Patching (banding effect)
Ruptured globe
Lid margin
lacerations, corneascleral laceration,
and prolapsed uvea
May require
enucleation to
reduce risk of
sympathetic
ophthalmia
Globe Rupture: Left Eye
Shallow anterior
chamber
Hyphema
Traumatic cataract
Vitreous hemorrhage
Vitreous rupture
Contusions of the Eyeball
Hyphema
Subconjunctival
Hemorrhage
Iridodialysis
Injury to the Posterior Structures
Vitreous Hemorrhage
Retinal Detachment
Choroidal Rupture
Chemical Burn
PLAN
•Irrigation
•Debridement
•Cyclopegia
•Antibiotic
•Artificial tears
Thermal Burn
Examples: Curling Iron Burn. UV Irradiation. Sun Viewing.
X-ray Radiation.
Plan: Pressure patching and antibiotics.
Orbital Fracture/
Periorbital Contusion Hematoma
Fracture fragments and
herniation of periorbital
tissues into the maxillary
sinus
Blow-out Fracture
Superior rim:
Traumatic Optic
Neuropathy
Know when to repair.
Know when to refer.