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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