Download Eye injury Lecture

TMA
Department of eye diseases
Ocular traumas
Types of Eye Injury
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There are a great variety of possible eye injuries but
they tend to fit into the following basic types.
Blunt ocular traumas
Penetrating ocular traumas
Non-penetrating ocular traumas
Chemical eye injuries
Minor superficial eye injuries:
corneal abrasions
corneal and conjunctival foreign bodies
conjunctival lacerations
Eyelid injuries
Orbital injuries and fractures
Burns of cornea, conjunctiva and eyelid
Distribution
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Burns
Penetrating eye injuries
Non-penetrating
eye injuries
2
10
6
%
80
Blunt injuries
Blunt trauma of soft tissues and
orbit
Injuries are divided by localization:
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Blunt traumas of soft tissue and orbit
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Closed fractures of orbit
Blunt traumas of soft
orbital tissues
Signs:
- Subconjunctival haemorrage
- Haematoma of eyelids
- Absence of ocular movements
Orbital fractures
signs:
- diplopy
- enoftalm
- absence of ocular
movements
Orbital fractures
а
b
c
a) Fractura of medial wall of the
eye ( emphyzema of eyelids)
b) Fracture of lateral and inferior
walls of orbit of right eye
с) Fracture of the superior wall of
orbit, haematoma of eyelids
First-aid tactics
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First aid for injuries of surrounding soft
tissues: on-site imposition of cold for 1-2
hours (ice, wet wipes).
Maintaining hemostatic vasoconstrictors
(menadione, vitamin K, Ascorutinum
calcium chloride 10%).
Immediately send to ophthalmologist.
Blunt injuries of eye (contusion)
Divided according to severity:
Mild - complete recovery
 Medium - small residual symptoms do not
affect visual function
 Severe - there are large morphological and
functional disorders
 Very severe - Rough morphological
changes, loss of function
Blunt injuries of the eye
Mechanism of eyeball contusion (schematic view)
Blunt injuries of the eye
Signs:
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Subconjunctival haemorrage
Corneal erosion
Hyphaema
Haemophthalm (vitreous haemorrhage)
Iridodonezis (trembling of iris)
Mydriazis
Subluxation of lens
Iridodializis (detachment or tear of the iris)
Choroidal or retinal ruptures
Retinal detachment
Avulsion of an optic nerve
Choroidal or retinal ruptures
Oedema of the cornea and
hyphema
Ruptura of the pupillae
Blunt injuries of the eye
Iridodializis
Dislocation of the lens
Blunt injuries of the eye
Choroidal ruptures
Choroidal ruptures and
partial haemophthalmos
Horoidal or retinal ruptures
Traumatic avulsion of optic
nerve
Retinal detachment
Blunt injuries of the eye
Subconjunctival ruptures of eye
First-aid tactics
Instillation into the conjunctival sac
of antibiotics or sulfa eye drops
 Anesthesia (local and general)
 Easy aseptic bandage
 Immediately send to ophthalmologist
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Injuries of surrounding
tissues
By localization injuries are divided into:
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Injuries of eyelids
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Lacrymal ducts injuries
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Foreign bodies
Injuries of eyelids
Lacerative crush wound
of lower eyelid
Lacerative crush wound
of upper and lower eyelids
Lacrymal ducts injuries
Laceration of the lower eyelid, with injury
of lacrimal duct
Foreign bodies of the orbit
Wooden foreign body is located in the
right orbit and labyrinth (MRI)
First-aid tactics
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Tetanus toxoid
Washing the wound with disinfectant
solutions
Parenteral (i/m) administration of
antibiotics
Easy aseptic bandage
Immediately send to ophthalmologist
Wounds of an eyeball
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Divided by localization:
Corneal wounds
Scleral wounds
Corneoscleral wounds
By penetrating of external walls
Penetrating injury
Non-penetrating injury
Penetrating injuries are divided into 2:
With intraocular foreign body
With exit of intraocular tissues from the wound
Wounds of an eyeball
Penetrating injury of cornea,
absence of anterior chamber
Penetrating injury of cornea,
anterior chamber is present
Eyeball injuries
Penetrating injury of cornea
with exit of iris
Penetrating corneaal wound
complicated with lens
opacification
Eyeball wounds
Penetrating wound of sclera
with exit of iris
Corneoscleral penetrating
injury with foreign body
Injuries of an eyeball
Borders of cornea are
adapted, penetrating wound
with foreign body in anterior
chamber.
Penetrating scleral wound
with foreign body.
First-aid tactics
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Tetanus toxoid
Washing the wound with disinfectant
solutions
Parenteral administration of antibiotics
Binocular aseptic bandage
Immediately send to ophthalmologist
Treatment tactics
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Performed by ophthalmologist in specialized
clinics:
X-ray of the orbit in the front and lateral
projections
X-ray of orbit by Komberg – Baltin
Primary surgical treatment of wounds
Reconstructive operations routinely if necessary.
Injuries of eyeball
Severe complications after penetrating
wounds of the eyeball
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Endophthalmitis
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Panophthalmitis
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Sympathetic ophthalmia
Thermic and chemic burns of
eyes
Burns of eyelids and conjunctiva are
divided by severety
I (mild) degree - redness and swelling
II (average) degree – bubbles
III (severe) degree - ischemia and necrotic zone
IV (very severe) degree - necrosis
Thermic and chemic burns of
eyes
Classification by severety:
I (mild) degree – hyperemia of eye tissues,
oedema, superficial corneal erosion.
II (medium) degree – deep corneal erosion,
oedema, ishchemisation of conjunctiva and
limbus area
III (severe) degree – in addition to the above
mentioned corneal opacification like misted
glass in the necrotic zones
IV (very severe) degree – porcelain cornea, total
necrosis of conjunctiva, perforation
Thermic and chemic burns of
eyes
Mudium degree of chemical
burn of conjunctives.
Ischemic zone of lymbic
area
Medium degree of chemical
burn of corneal layer
Кўз олмаси термик ва
кимёвий куйишлари
chemical burns, severe lens
chemical burns of the eyeball
is extremely severe
Кўз олмаси термик ва
кимёвий куйишлари
chemical burn extremely
severe. complications of
cataract lens
chemical burn extremely
severe. edematous cataract,
secondary glaucoma
Thermic and chemic burns of
eyes
Very severe thermic burn
Very severe thermic burn
Thermic and chemic burns of
eyes
Very severe thermic burn of eyeball and surrounding
tissues
Thermic and chemic burns of
eyes
Severe theromochemical burn ofVery severe thermochemical burns,
an eyeball. 1 month after the
complicated cataract
injury.
First-aid tactics
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Removing of burn agent
Washing the conjunctival sac during 10-15 minutes.
Using buttered solutions
Immediately send to ophthalmologist
In the hospital:
Anesthesia
Washing of lacrimal ducts
The introduction of autologous blood under the
conjunctiva
In case of severe burns, tetanus toxoid injection
Disinfecting, vitamin solutions
Parenteral injection of antibiotics
Binocular aseptic bandage
Thermic and chemic burns of
eyes
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the outcome of burns mild to moderate
favorable
burns of moderate and severe usually leave
behind changes require surgery
children with complications from burns of
moderate and severe group are entered in
the prevention of ocular pathologies and for
a long time kept under medical observation
Prophylaxis of ocular traumas
Prevention consists of two stages:
The first step, i.e. Primary prevention - preventive
measures among the population at home, on the
streets, in schools, kindergartens.
The second stage, i.e. secondary prevention - early
diagnosis, urgent measures to actively integrated
medical and surgical treatment to help to prevent
dangerous complications such as purulent and
phacogenic uveitis, metallosis, hypotension eyeball and
sympathetic ophthalmia.