Download Ocular injury

Ocular Injury
Department of Ophthalmology
Tianjin Medial University General Hospital
Hua Yan, MD, PhD
[email protected]
www.apots.org
General description
• The structure of the visual organ
is very fine and weak
• Lose the ability to work
• Difficulties and sufferings in life
• Prompt and right management
Classification of ocular injury
• Mechanical ocular injury
Contusion
Laceration
Rupture
• Non-mechanical ocular injury
ocular chemical burns
thermal burns
radiation damage
Classification of mechanical ocular injury
Ocular injury
Closed injury
Contusion
Open injury
Lamellar laceration
Penetrating
Laceration
IFB
Rupture
Perforation
Mechanical injury of the eye
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Make up more than 80% of the total injuries
metal fragment,
instruments in work,
knife,
scissors,
needle,
pliers,
shells,
ears of wheat and grain,
spots instruments,
toys at home,
explosive flying stone,
iron piece,
shell fragment in battlefield
Mechanical injury of the eye
• Take place
young workers
students
youth
people short of experience in work
Orbital Injury
Orbital injury - clinical findings
• Fracture of orbital wall and nearby cranial
bone, nasal sinuses and optic canal (leading to
optic nerve atrophy)
• Fracture of the ethmoid sinus (subcutaneous
emphysema)
• Injuries of the eyelids, the globe and deep soft
tissue of the orbit (orbital cellulitis)
• Intraorbital hemorrhage may induce
exophthalmos and palpebral ecchymoma
Orbital injury - treatment
• Complications of nervous or systemic system •
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management
Closed simple fracture of the orbital bony rim - no
special treatment
Severe injury of skull, reflex of the pupil should be
examined
Severe injury of soft tissue - debridement and
suturing layer, TAT and antibiotic
Large foreign body in the orbit should be extracted as
early as possible
Small and deep ones, generally extractive operation
isn’t needed.
Intraobital hemorrhage - pressure bandage
Palpebral injury
Palpebral injury - clinical findings
• Palpebral skin is thin and loose, it is quite easy to be
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healed after injury and the infection is rare
Palpebral swelling and hemorrhage
Subconjunctival hemorrhage may spread into the
subcutaneous tissue of another eye through the nose
bridge
Breakdown of the palpebral margin
Breaking of ligaments of the inner and outer canthi
Palpebral injury - treatment
• The palpebral edema and hemorrhage may be
absorbed spontaneously
• Fresh wound must be debridement and sutured
as early as possible
• Tetanus antitoxin (TAT)
• Antibiotic
Conjunctival foreign body - clinical
findings
• Dust, coal dust and small insect
• Most of the foreign bodies are pushed into the
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inferior tarsal sulcus of the upper eyelid
Foreign body sensation, pain, tearing, and palpebral
spasm
Conjunctival hyperemia
Eyelid is everted, fine foreign body often lodges in
the lower tarsal sulcus of the conjunctiva in the upper
eyelid
Conjunctival foreign body - treatment
• Removed by wet cotton roll or clean towel
Corneal foreign body
Corneal foreign body - etiology
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Metal pieces
Dust in atmosphere
Insects
Husks
Explosive injury
Corneal foreign body - clinical
findings
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Foreign body sensation
Pain
Photophobia
Tearing
Palpebral spasm
Corneal foreign body - treatment
• Don’t rub the eye
• Remove with cotton-tipped applicator after
surface anesthesia with 0.5%-1% dicaine
solution
• After several hours of existing, an iron pieces
arouses siderosis on its surrounding tissue
• Rust is difficult to be removed clearly
Penetrating injury
of the globe
Penetrating injury of the globe
• Beat something with a hammer, splashing pieces to
eye
• The severity of penetrating injury is related to many
factors
Size
Shape
Character of instruments causing trauma
Splashing velocity
Injured site
Polluted degree
Penetrating injury of the globe –
clinical findings
• Direct damage to ocular tissue
– Corneal penetrating injury
– Prolapse of intraocular contents
– Secondary glaucoma
– Traumatic cataract
– Intraocular hemorrhage
Severity of penetrating injury
• Endophthalmitis---Intraocular infection
• Intraocular foreign body
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– Inflammatory reaction
– Metal foreign body may harm intraocular tissue
Sympathetic ophthalmia
– Sometimes penetrating injury or intraocular
foreign body in one eye leads to severe uveitis in
another eye which is called sympathetic
ophthalmia
Penetrating injury of the globe treatment
• Don’t squeeze injured eye on examination
• Emergency treatment
 clean the wound
 instill antibiotic ointment and bandage both eyes
 transmit the wounded to hospital in time
 tetanus antitoxin
• Corneal, scleral wound should be sutured as early as possible
• As for corneal or scleral wound with prolapse of the uvea, if it
is within 24 hours, the wound is clean, the prolapsed tissue
may be replaced into the eye
Penetrating injury of the globe treatment
• In order to prevent iris incarceration, injection of air
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into the anterior chamber should be done
For the corneal line wound which is less than 3mm
with no incarceration, the anterior chamber is restored
all or partially, suture isn’t needed
Minor and closed scleral wound needn’t be sutured
Inject antibody into subconjunctiva
Examination next day
Intraocular foreign body
Intraocular foreign
body
• Commonly occurred in eye injury
• Steel, iron, copper, non – metal foreign body
• In the anterior chamber, lens, vitreous, incarcerated in
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the retinal and uvea
Stable substance such as gold, silver, glass, stone and
etc may lead to simple exudative reaction surrounding
the foreign body
Steel and iron within the eye bring about severe
reaction
Intraocular foreign body - diagnosis
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Injury history
Signs
Ocular examination
X ray
CT
Preoperative examinations
Visual acuity
Slit lamp examination
Direct and indirect Ophthalmoscopy
(mydriatic)
B-scan
Intraocular foreign body - treatment
• Magnetic IOFB
– In the anterior chamber
– In the lens
– In the posterior part of the globe
• Non–magnetic IOFB
– In the anterior chamber
– In the lens
– In the posterior part of the globe
Review
• Classification of ocular injury ?
• Harm of penetrating injury of the globe ?
• Treatment of penetrating injury of the globe ?