Download globe injury - Medical Students Knowledge Marathon of India

SABARI DAS S
III MBBS
K S HEGDE MEDICAL ACADEMY
MANGALORE
Ocular Injuries
Closed-globe
Open-globe
Contusion
Globe rupture
Lamellar
laceration
Laceration
Closed-globe
injury
Lesions
Globe rupture
Extraocular
lesions
• Ecchymosis – ‘black eye’
• Laceration and avulsion of lids
• Traumatic ptosis
• Subconjunctival haemorhage
• Chemosis and lacerating wounds
• Dislocation of lacrimal gland
• Laceration of lacrimal passages
• Optic nerve injuries
• Blow out fracture of the orbital floor
• Cornea
• Vitreous
• Sclera
• Choroid
• Anterior Chamber
• Retina
• Iris, pupil & ciliary
body
• Intraocular pressure
changes
• Lens
• Traumatic changes in
refraction
• Simple abrasions
• Recurrent corneal abrasions (recurrent
traumatic keractalgia)
• Partial corneal tears ( lamellar corneal
laceration)
• Tears in the Descemet’s membrane
• Acute corneal edema
• Blood staining of cornea
Corneal Abrasion
Corneal Edema
• Partial thickness scleral wounds ( lamellar
scleral lacerations)
• May occur alone or in association with other
lesions of closed globe injury
Traumatic hyphema
• Blood collection in the anterior chamber
• Due to rupture of the iris or ciliary body vessels
Treatment
• Conservative : prevention of IOP rise and secondary
haemorrhage
• Surgical: surgical drainage of large non-resolving
hyphema to avoid blood staining of cornea
Traumatic hyphema
• Traumatic miosis
• Traumatic mydriasis (Iridoplegia)
• Rupture of pupillary margin
• Radiating tears in the iris stroma
• Iridodialysis : detachment of iris from its root at
the ciliary body resulting in a D-shaped pupil
• Antiflexion of iris : rotation of detached
portion of iris in which the posterior surface
anteriorly
• Retroflexion of iris : whole iris is doubled back
in the ciliary region and becomes invisible.
• Traumatic aniridia : completely torn iris sinks
to the bottom of the ciliary body in the form of
a minute ball
Angle recession
• tear between the longitudinal and circular
muscle fibers of the ciliary body.
• Deepening of anterior chamber and widening
of ciliary body band on gonioscopy.
• complicated by glaucoma
Inflammatory changes
such as traumatic
iridocyclitis, haemophthalmitis, post-traumatic
iris atrophy and pigmentary changes.
Vossious ring
• Circular ring of brown pigment seen on the anterior
capsule
• Occurs due to striking of the contracted pupillary
margin against the crystalline lens
• Smaller than the size of the pupil
Concussion Cataract
• Occurs mainly due to imbibition of aqueous and
partly due to direct mechanical effects of injury on
the lens fibers.
• Presence of discrete subepithelial opacities and
rossette shaped cataract
Other lesions
• Traumatic absorption of lens : aphakia (children)
• Subluxation or dislocation of lens
• Liquefaction and appearance of clouds
• Vitreous detachment (PVD)
• Vitreous haemorrhage
• Vitreous herniation
• Rupture of the choroid
• Choroidal haemorrhage
• Choroidal detachment
• Traumatic chorioditis
• Commotio retinae ( Berlin’s edema)
• Retinal haemorhages
• Retinal tears
• Traumatic proliferative retinopathy ( Retinitis
proliferens)
• Retinal detachment
• Concussion changes in the macula
• Traumatic glaucoma
• Traumatic hypotony
• Myopia : due to ciliary spasm or rupture of
zonules or anterior shift of the lens
• Hypermetropia and loss of accomodation due
to damage to ciliary body (Cycloplegia)
Globe rupture
Direct Rupture
Indirect Rupture
• Prolapse of uveal tissue
• Vitreous loss
• Intraocular haemorrhage
• Dislocation of lens
• Initial rise in IOP
• Accompanying signs : irregular pupil,
hyphema, commotio retinae, choroidal
rupture and retinal tears
• Repair of tear in the eye wall
• Postoperative treatment: antibiotics, steroids
and atropine.
• Enucleation in a badly damaged eye where
salvation is not possible