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    OCULAR TRAUMA & Chemical Injury

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    gyogi1989
    Ocular trauma can occur through various means and requires prompt evaluation and treatment to prevent vision loss. The eye is vulnerable to injury from chemicals, heat, radiation, and physical trauma. Some key points about ocular trauma include that it is an ocular emergency, a leading cause of blindness, and efficient referral is important. Trauma is classified by etiology, nature of injury, and extent of damage. Evaluation involves assessing the history, nature, and severity of the injury along with specialized imaging when needed. Management depends on the type and severity of injury but generally aims to clean the wound, remove any foreign bodies, and close tissues in layers. Complications can include scarring, infection, and visual impairment so careful repair and

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    OCULAR TRAUMA & Chemical Injury

    Uploaded by

    gyogi1989
    64 views51 pages
    Ocular trauma can occur through various means and requires prompt evaluation and treatment to prevent vision loss. The eye is vulnerable to injury from chemicals, heat, radiation, and physical trauma. Some key points about ocular trauma include that it is an ocular emergency, a leading cause of blindness, and efficient referral is important. Trauma is classified by etiology, nature of injury, and extent of damage. Evaluation involves assessing the history, nature, and severity of the injury along with specialized imaging when needed. Management depends on the type and severity of injury but generally aims to clean the wound, remove any foreign bodies, and close tissues in layers. Complications can include scarring, infection, and visual impairment so careful repair and

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    OCULAR TRAUMA & chemical injury

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    Ocular trauma can occur through various means and requires prompt evaluation and treatment to prevent vision loss. The eye is vulnerable to injury from chemicals, heat, radiation, and physical trauma. Some key points about ocular trauma include that it is an ocular emergency, a leading cause of blindness, and efficient referral is important. Trauma is classified by etiology, nature of injury, and extent of damage. Evaluation involves assessing the history, nature, and severity of the injury along with specialized imaging when needed. Management depends on the type and severity of injury but generally aims to clean the wound, remove any foreign bodies, and close tissues in layers. Complications can include scarring, infection, and visual impairment so careful repair and

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    64 views51 pages

    OCULAR TRAUMA & Chemical Injury

    Uploaded by

    gyogi1989
    Ocular trauma can occur through various means and requires prompt evaluation and treatment to prevent vision loss. The eye is vulnerable to injury from chemicals, heat, radiation, and physical trauma. Some key points about ocular trauma include that it is an ocular emergency, a leading cause of blindness, and efficient referral is important. Trauma is classified by etiology, nature of injury, and extent of damage. Evaluation involves assessing the history, nature, and severity of the injury along with specialized imaging when needed. Management depends on the type and severity of injury but generally aims to clean the wound, remove any foreign bodies, and close tissues in layers. Complications can include scarring, infection, and visual impairment so careful repair and

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    OCULAR TRAUMA

    Ocular Trauma

    • The eye is protected from direct injury by lids, eyelashes


    and the projecting margins of the orbit.

    • Nevertheless, it can be injured in a variety of ways; by


    chemicals, heat, radiation and mechanical trauma.
    Some key features of ocular trauma:

    • It is an ocular emergency.
    • Leading cause of blindness, irrespective of age, gender
    and geographical status. (40% of monocular blindness)
    • Male & young age group is greater in incidence rate.
    • Efficient referral expected from the professionals.
    • Every persons should know about the importance of quick
    response to an ocular injury.
    Classification of Trauma

    • Etiological Classification

    1. Accidental trauma.
    2. Self inflicted trauma.
    3. Occupational trauma.
    Classification according to nature-

    • 1. Physical trauma

    • a. Perforating
    • b. Non perforating
    • c. Blunt trauma

    • 2. Chemical trauma
    • a. Acid
    • b.Alkali
    Contd..

    • 3. Thermal trauma

    • a. Heat
    • b. Cold

    • 4. Radiation trauma

    • a. Ionizing agents
    • b. Ultra violet rays
    Uniform classification based on primary
    evaluation;
    • Mechanical trauma to the eye are of two types:
    • 1. Open globe injuries
    • — full thickness defect of eye coats.
    • 2. Closed globe injuries
    • — iniuries without full thickness of
    • Mechanical eye injuries
    Mechanical eye injuries

    • Closed-globe injuries
    • a. Concussion or Contusion
    • b. Lamellar laceration
    • Open-globe injuries
    • a. Laceration
    • Penetrating injuries
    • Perforating injuries
    • b. Rupture
    Assessment:

    • History-
    • should be detailed as possible
    • time & nature of injury
    • missile,blunt,?FB remaining,chemical etc.
    • Past ocular history - VA, lid function
    • Immunization history
    • Rule out life threatening injuries
    • Rule out globe threatening injuries
    Eyelid trauma

    • ' Periocular Haematoma :


    • - Generally innocuous but it is very important to exclude
    1. Trauma to the globe or orbit
    • 2. Orbital roof fracture
    • 3. Basal skull fracture
    • Laceration •
    • 1. Superficial lacerations
    • 2. Lid margin lacerations
    • 3. Lacerations with mild tissue loss
    • 4. Lacerations with extensive tissue loss
    • 5. Canalicular lacerations
    Repair

    General principles of repair:


    • 1. Clean the wound
    • 2. Remove foreign body
    • 3. Careful handling of tissues
    • 4. Careful alignment of anatomy
    • • lid margins,lash line,skin folds, etc.
    • 5. Close in layers
    • 6. Timing
    Repairing procedure

    1. Superficial lacerations without gaping


    can be sutured with 5-0
    / 6-0 black silk, removed after 5 days
    2. Lid margin laceration
    - Carefully align to prevent notching
    a. Align with 5-0 silk suture
    b. Close tarsal plate with fine
    absorbable suture (5-0 vicryl)
    c. Place additional marginal silk
    Canalicular lacerations repair:

    • - Repair within 24 hours


    • - Locate & approximate ends
    • - Bridge the defect with silicone tubing
    • - Leave the tube in situ for 3-6 months
    Complications

    • - Lid margin notching


    • - Lagophthalmos
    • - Hypertrophic scar
    • - Infection
    • - Tearing — canalicular damage, lid
    malposition, pump failure
    • - Ptosis
    Orbital fractures

    Types :
    • Blow-out orbital floor fracture
    • Blow-out medial wall fracture
    • Roof fracture
    • Lateral wall fracture
    • Blow-out orbital floor fracture
    Mechanism of an orbital floor blow-out fracture
    Signs of orbital floor blow-out fracture

    • Periorbital ecchymosis,
    oedema and emphysema
    may also present
    • Infraorbital nerve
    anaesthesia
    • Ophthalmoplegia tipically
    in up and down-gaze
    (double diplopia)
    Investigations
    Surgical repair of orbital floor blow-out fracture
    Medial wall blow-out fracture
    Signs & Investigation
    Trauma to the Globe

    • • Principles of Evaluation:
    • 1. Initial assessment
    • a. Determination of nature, extent, life threatening
    problems
    • b. History of the injury, including the circumstances, timing
    and likely object
    • c. Thorough examination of eyes and the orbits
    • 2. Special investigations
    • a. Plain X-ray
    • b. CT scan
    Blunt Trauma
    Pathogenesis of ocular damage by blunt trauma
    Anterior segment complications of blunt trauma
    Corneal complications
    Corneal Abrasion
    Stromal Oedema
    Pupillary complications

    Vossius rings
    Lens complications of blunt trauma
    Posterior segment complications of blunt trauma
    Commotio ratinae

    (A) Perioheral (B) central (C) macular hole


    Choroidal rupture
    Retinal breaks and detachment

    Avulsion of the vitreous base Equatorial breaks Macular holes


    Penetrating trauma
    Complications of penetrating trauma

    Penetrating corneal wounds


    Penetrating corneal wounds
    Foreign Body
    Superficial foreign body
    Management:

    • a. Careful sl it-lamp examination for exact position &


    depth
    • b. Removal under slit-lamp with 26-gause needle
    • c. Magnetic removal for a deeply embedded metallic
    foreign bod
    • c. Residual 'rust ring' may remove with sterile 'burr'
    • d. Antibiotic oint. with cycloplegic and/or NSAlDs
    Inraocular Foreign Body

    (A) In the lens (B) In the angle


    Management:

    • a. Accurate history- helpful for nature of FB


    • b. Examination
    • • Entry exit point
    • • Gonioscopy & fundoscopy must
    • • Documentation for damaged structure
    • c. CT scan
    • d. MRI contraindicated for metalic FB
    Removal technique
    Chemical Injury

    Key features:
    • Majority of injuries are accidental
    • Few due to assault
    • 2/3 rd of accidental burns occur at work pla
    • Alkali burns are twice as common as acid
    • Alkali burns more severe than acid
    Grading of severity of chemical injuries

    Grade I (excellent prognosis)


    • Clear cornea
    • Limbal ischaemia - nil • G - ll
    Grade Il (good prognosis)
    • Cornea hazy but visible iris details
    • Limbal ischaemia <1/3
    Grade Ill (guarded prognosis)
    Hazy cornea with no iris • G - Ill
    details
    Medical Treatment of Chemical Injuries

    • 1. Copious irrigation (15-30 min) — to restore normal pH


    • 2. Topical steroids (first 7-10 days) — to reduce
    inflamation
    • 3. Topical and systemic ascorbic acid — to enhance
    collagen production
    • 4. Topical citric acid — to inhibit neutrophil activity
    • 5. Topical and systemic tetracycline — to inhibit
    collagenase and neutrophil activity
    Surgical Management of Severe Chemical
    Injuries
    Thank you

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