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Last updated on 26 Oct 2016 at 8:25 AM (Oph02)
Acute trauma to the eye
A 23 year old NZ European male presents to an Emergency Department with reduced
vision, severe pain and redness in his right eye. Wet concrete had sprayed into the eye
from a concrete hose approximately 2 hours earlier. His vision is poor and the right
eye feels harder than the left eye to palpation
Applied Science for Medicine
Anatomy of the adnexal structures of the eye (lids, lacrimal structures)
Anatomy of the conjunctiva, limbus, cornea and anterior chamber of the eye
Anatomy of the vascular supply to the eye
Physiology of the cornea, corneal clarity and corneal repair
Physiology of aqueous humour production and drainage
Understand the effect of acids and alkalis on ocular tissue (lids, conjunctiva, cornea
and anterior chamber)
Clinical and Communication Skills
Elicit a relevant history for eye trauma
Measure and record visual acuity
Evaluate corneal clarity; elicit signs of corneal epithelial defects, including use of
fluorescein
Perform gross evaluation of intraocular pressure by palpation
Recognise red flag symptoms and signs in relation to severe eye trauma
Perform focused examination of eye trauma paying particular attention to the lids,
conjunctiva and cornea with judgement of severity of trauma
Indications for imaging including CT, MRI, Retinal angiography, Xray
Working knowledge of the slit-lamp microscope in external eye disease
Identify signs of limbal ischaemia
Understand emergency management of eye trauma; recognise the extremely urgent
nature of chemical injuries to the eye and the need to perform urgent washout of the
eye prior to any other management
Management of ocular surface discomfort, ocular surface dryness and poor visual
acuity
Longer term surgical rehabilitation - lids, conjunctiva, cornea; management of
cosmetic problems from scarring
Driving standards for vision; occupational standards for vision (monocular and
binocular)/return to work capabilities
Consider role of other professionals in patient care - e.g. optometrists
Clinical reasoning - using key signs and symptoms to establish most likely diagnosis
and management
Patient education - appropriate recommendations including advice regarding risks
and appropriate protection against eye injury
Personal and Professional Skills
Team work - understanding the role of other ophthalmic and non-ophthalmic health
professionals in the immediate and ongoing management of acute chemical eye
injuries
Professional communication with distressed patient and with staff
Hauora MÄ•ori
Acknowledgement of the disproportionate impact of illness on whĕnau
employment/income; availability and models of caregiving
Population Health
Provision of emergency ophthalmic services for the management of acute severe
injury including chemical burns
Conditions to be considered relating to this scenario
acute eye trauma
Common