Download Ocular traumas presentation

Theme
Injuries of an organ of vision
Purpose of the lesson
 To teach to future general practitioner etiology,
pathogenesis, clinics, diagnostics, treatment and
prophylaxis of ocular traumas and show its
importance.
Student should know
Student should be able to
 Clinics and treatment of non-  Define tactics of management of
patients with ocular traumas and
penetrating injuries
burns
(contusions)
 Interpretation of the results of
 Clinics, complications of
laboratory tests and instrumental
penetrating wounds
examinations in patients with ocular
 Treatment and prophylaxis
burns
 Clinic symptoms of thermal and
 Consultation of patients with ocular
chemical burns and first aid.
traumas
 Sympathic inflammation,
 Diagnostics of fractures of orbital
symptoms and prophylaxis
bones
 Endophthalmitis and
 Differential diagnostics of different
panophthalmitis. GP tactics and
kinds of ocular burns
clinics.
 First aid to patients with ocular burns
introduction
The organ of vision is so arranged, that even the
most insignificant injuries can lead to decrease of
visual functions and even to blindness.
Results of the analysis of injuries of an organ of
vision show that more than 40% of complications
after injuries is connected with the wrong
evacuation of patients(Gundorovа R.А., Grishina
V.С., Polyakova М.К.).
introduction
Injuries of an eyeball and surrounding tissues :
 Contusions
 Penetrating wounds
 Non penetrating wounds
 Burns
introduction
 In our Republic the quantity of eye injuries
meets at 1-4 on 1000 population.
Burns
Penetrating wounds
2
10
Not penetrating wounds
6
%
80
Contusions
Contusions of soft tissues and orbit
By localization of a trauma :
Contusions of soft tissues of an orbit
The closed fractures of bones of an orbit
On severity:
Easy (I)
Average (II)
Heavy (III)
The heaviest (IV)
Contusions of soft tissues
Symptoms:
- Subconjunctival hemorrhages
- The expressed hematoma of eyelids
- Restriction of the movement of an eyeball
Fractures of bones of an orbit
Damage mechanism
lower wall of an orbit
Symptoms:
- Diplopi
- Enoftalm (and)
Movement restriction
eyeball up (b)
Fractures of bones of an orbit
а
b
c
a) Change of a medial wall of an
orbit (emphysema of eyelids)
b) Change of external and lower
walls of an orbit on the right
c) Change of a upper wall of an
orbit, hematoma of eyelids
Tactics of fist aid
 First aid at injuries of surrounding soft tissues: to
place to trauma imposing of cold for 1-2 hours
(ice, wet towel wipes).
 Maintaining haemostatic vasoconstrictive
preparations (Vikasol, vitamin K, ascorutin,
calcium chloride of 10%).
 Immediately direct to ophthalmologist.
Eyeball contusions
By severity:
Easy – an absolute recovery
Average – small residual signs the functions
which aren't influencing on vision
Severe – significant morphological and
functional violations are observed
The most severe – Rough morphological
changes, loss of functions
Eyeball contusions
Mechanism of contusions of an eyeball (scheme)
Eyeball contusions
Clinical signs:
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Subconjunctival hemorrhages
Cornea erosion
Hemorrhages in the anterior camera (hyphema)
Hemorrhages in a vitreous body (haemophthalmos)
Trembling of an iris (iridodenesis)
Expansions of a pupil (change of a form)
Partial (subluxation) or full (luxation) dislocation of lens
Separation or rupture of an iris (iridodialysis)
Rupture of chorioid and retina
Retinal detachment
Lesion of an optic nerve
Eyeball contusions
Hypostasis of a cornea,
hyphema
Pupil synechia
Eyeball contusions
Iridodialisis from a root
Lens dislocation in the anterior
chamber
Eyeball contusions
Rupture of chorioid
Traumatic rupture of chorioid,
partial haemophthalmus
Eyeball contusions
Traumatic rupture of an optic
nerve
Traumatic detachment of a retina
Eyeball contusions
Contusion of an eyeball of the IV degree, destruction of an
eyeball
Tactics of the first aid
 Instillation of antibacterial or sulphanilamyde eye
drops in conjunctival bag
 Anesthesia (local and general)
 Easy aseptic bandage
 Immediately direct to the ophthalmologist
Wounds of surrounding
tissues
By localization:
Wounds of eyelids
Wounds of lacrimal ways
Foreign bodies of an orbit
Wounds century
The fragmentary
wound of a lower eyelid
The fragmentary wound
of upper and lower eyelids
Wounds of lacrimal pathways
Separation of a lower eyelid with destruction
of lacrimal canalis
Foreign matter of an orbit
Foreign body (tree) is located in orbit and
trellised bosoms on the right (MR-the
tomogram).
Tactics of the first aid
 Introduction of an antitetanic anatoxin
 Wash of wound with disinfecting solutions
 Parenteral introduction of antibiotics
 Easy aseptic bandage
 Immediately direct to ophthalmologist
Wounds of an eyeball
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By localization:
Wounds of cornea
Wounds of sclera
Corneoscleral wounds
By relation of integrity of an external cover of an
eyeball
Penetrating wounds
Not penetrating wounds
The penetrating wounds share:
With an intraocular foreign body
With loss of internal layers
Wounds of an eyeball
Penetrating wound of cornea,
absence of the anterior chamber
Penetrating wound of cornea,
anterior camera is present
Wounds of an eyeball
Penetrating wound of cornea
with loss of an iris
Penetrating wound of cornea
complicated by traumatic
cataract
Wounds of an eyeball
Penetrating wound of sclera
with loss of iris
Corneoscleral wound with a
foreign body.
Wounds of an eyeball
Penetrating wound of cornea with
the adapted edges and foreign body
in the anterior chamber
Penetrating wound of sclera
with a foreign body in a wound.
Tactics of the first aid
 Introduction of an antitetanic anatoksin
 Washings of a wound disinfecting solutions
 Parenteral introduction of antibiotics
 Binocular aseptic bandage
 Immediately direct to ophthalmologist
Treatment tactics
 Conducting the qualified help in conditions of
clinic:
 Orbit X-ray analysis in forward and lateral
projections
 Orbit X-ray analysis by Komberg – Baltin
 Primary surgical processing of wounds
 Carrying out reconstructive operations in a
planned order
Wounds of an eyeball
Severe complications after penetrating
wounds of an eyeball
 Endophthalmitis
 Panophthalmitis
 Sympathetic ophthalmia
Thermal and chemical burns of
an organ of vision
Classification of burns of eyelids and conjunctiva
according to degree of burns of skin
other localizations
The I (easy) degree – a hyperemia and hypostasis
The II (average) degree – bubbles
The III (severe) degree – an ischemisation and necrotic
zones
The IV (heaviest) degree – necrosis of tissues
Thermal and chemical burns of
an organ of vision
By severity:
The I (easy) degree – a hyperemia of eyelids and
conjunctiva, hypostasis and a superficial erosion of
cornea
The II (average) degree – deep erosion and hypostasis of
cornea, ischemia of conjunctiva and limb
The III (severe) degree – joins cornea hypostasis in the
form of "opaque glass", necrotic zones of a conjunctiva
(scab)
The IV (the most severe) degree – a cornea in the form of
"porcelain glass", a total necrosis of conjunctiva and
perforation
Thermal and chemical burns
of an organ of vision
Chemical burn of conjunctiva
of average degree. Ischemic
zones of a limb.
Chemical burn of a cornea of
average degree.
Thermal and chemical burns
of an organ of vision
Chemical burn of cornea of severe
degree.
Chemical burn of an eyeball of
the most severe degree.
Thermal and chemical burns
of an organ of vision
Thermal burn of average degree
Thermal burn of the most severe
degree
Thermal and chemical burns
of an organ of vision
Thermal burn of an eyeball and surrounding tissues of the heaviest
degree
Thermal and chemical burns
of an organ of vision
Thermochemical burn of severe Thermochemical burn of the heaviest
degree. 1 month after a burn
degree, the complicated cataract
Tactics of the first aid
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Removal of the burn agent
Washing of a conjunctival sac during 10-15 min.
Use of buttered solutions
Immediately direct to the ophthalmologist
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In a hospital:
Anesthesia
Washing of lacrimal ways
Introduction of an autoblood under conjunctiva
At burns of heavy degree introduction of an antitetanic anatoxin
Disinfecting, vitamin solutions
Parenteral introduction of antibiotics
Binocular aseptic bandage
Prevention of injuries of an organ of
vision
Prevention consists of 2 stages:
The first stage, i.e. primary prevention – carrying out
preventive measures among the population at home,
on streets, at schools, kindergartens.
The second stage, i.e. secondary prevention – early
diagnostics, carrying out urgent actions for active
complex drug and surgical treatment help to prevent
dangerous complications as purulent and phacogenic
uveitis, metallosis, hypotonia of an eyeball and a
sympathetic ophthalmia.
Questions for control
 Symptoms of blind traumas of an eye, diagnostics, treatment.
 Superficial and deep traumas of an eyeball (symptoms, complications,
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treatment, prevention)
Thermal and chemical burns of an eye (symptoms, complications,
treatment and prevention).
Sympathic inflammation, reasons, symptoms, treatment and prevention.
How should one perform differential diagnostics of acute iridocyclitis
with acute attack of angle-closure glaucoma.
Endophthalmitis and panophthalmitis (reasons, symptoms, treatment
and prevention)
X-ray localization of intraorbital foreign bodies
Clinics and diagnostics of non-penetrating and penetrating ocular
traumas.
Traumas of orbit and accessorius apparatus.
Prevention of ocular traumas.