By Dnyaneshwar bhagwan potfode

1. Dnyaneshwar bhagwan potfode

2. Learning Objectives
 To be able to identify and evaluate patients with ocular
trauma.
 To be able to give primary first aid to the patient before
referral.
 To be able to understand the importance of personal
protective equipments and promote awareness about
the same.
PBMA’S H. V. DESAI EYE HOSPITAL

3. Eyelid
Trauma
Orbital
Trauma
Trauma
to Globe
Chemical
Injury
PBMA’S H. V. DESAI EYE HOSPITAL

4. EVALUATION
 History
 General condition
 Visual acuity
 Complete ocular examination
 Assist examination
 “Do not forget the Vitals”
Visual acuity.
Pupillary size, shape and reaction to light.
Extra ocular movements.
PBMA’S H. V. DESAI EYE HOSPITAL

5. Eyelid Trauma
 Periocular Haematoma
 Ecchymosis
 Exclude :
-Trauma to globe/orbit
-Orbital roof fracture
( check the post limit of SCH
if noted)
- Basal Skull fracture (
bilateral ring haematomas)
PBMA’S H. V. DESAI EYE HOSPITAL

6. Laceration
 Direct closure preferable
 Minor lid lacerations not
involving the lid margin or
tarsal plate may be repaired
with nylon (or, in children,
plain gut) 6-0 or 7-0
sutures.
 Uncomplicated contusions
are treated with ice packs to
inhibit swelling during the
first 24 to 48 Hrs followed
by hot compresses to aid
absorption of the
hematoma.
PBMA’S H. V. DESAI EYE HOSPITAL

7. ORBITAL TRAUMA- Blow Out Fracture
 Sudden increase in orbital
pressure from impacting
object, greater in diameter
than orbital aperture > 5
cm.
 Ecchymosis ,edema,s/c
emphysema
 Diplopia
 Anaesthesia of lower lid
cheek,side of nose, upper
lip,teeth,gums.
 Enophthalmos
 Exclude intraocular damage
PBMA’S H. V. DESAI EYE HOSPITAL

8. Treatment
 Diagnosis best made by CT scan.
 If diplopia or cosmetically unacceptable enophthalmos
persists beyond 2 wk, surgical repair is indicated.
 Using a topical vasoconstrictor for 2 to 3 days may help
patients with epistaxis.
 NOT TO BLOW NOSE.
PBMA’S H. V. DESAI EYE HOSPITAL

9. Orbital Haemorrhage
 Retrobulbar haemorrhage-
compressive optic
neuropathy
 Proptosis,ecchymosis,
 EOM restriction
 Decreased V/A
 Treatment:
 Immediate treatment
 Canthotomy f/b
cantholysis at the lateral
canthus.
PBMA’S H. V. DESAI EYE HOSPITAL

10. TRAUMA TO GLOBE
PBMA’S H. V. DESAI EYE HOSPITAL

11. Investigations
 Plain X Rays
 Ultrasonography
 CT scan
 MRI
PBMA’S H. V. DESAI EYE HOSPITAL

12. BLUNT TRAUMA
PBMA’S H. V. DESAI EYE HOSPITAL

13. Effect on Conjunctiva
 Laceration
 Sub-conjunctival Haemorrhage
 Chemosis
 Congestion
 Tear
. Occasionally foreign body
 Treatment:-
SOS suturing
Lubricants
Antibiotics
PBMA’S H. V. DESAI EYE HOSPITAL

14. Cornea
 Laceration
 Ulceration
 Perforation
 Acute Corneal Edema
TREATMENT:-
 Antibiotics
 Lubricants
 SOS eyepatch
 SOS Repair
 Regular follow up
PBMA’S H. V. DESAI EYE HOSPITAL

15. Effect on Iris and Ciliary Body
 Post traumatic iridocyclitis
 Traumatic miosis
 Traumatic mydriasis
 Hyphema
 Radiating lacerations
 Tear of sphincter
 Iridodialysis
 Angle recession
 Traumatic aniridia
 Ciliary shock
PBMA’S H. V. DESAI EYE HOSPITAL

16. Effect on lens
-Cataract Dislocation
-Vossius ring
- Concussion
Cataract (rosette)
PBMA’S H. V. DESAI EYE HOSPITAL

17. Traumatic Cataract
PBMA’S H. V. DESAI EYE HOSPITAL

18. Effect on vitreous
 Detachment
 Hemorrhage
 Opacities
PBMA’S H. V. DESAI EYE HOSPITAL

19. Effects on
Retina
 Pre retinal
haemorrhage
 Detachment
 Macular
oedema
 Macular hole
 Pigmentary
degeneration
PBMA’S H. V. DESAI EYE HOSPITAL

20. Effect on optic nerve
 Optic nerve
avulsion
 Optic nerve
laceration
PBMA’S H. V. DESAI EYE HOSPITAL

21. CHEMICAL INJURY
 Acids: acetic, H2SO4, H2S, HCl,
HFl
 Alkali- Caustic soda, Lime, Sod.
hydroxide.
Mechanism of action:
 Necrosis of surface epithelium &
occlusion of Limbal vasculature.
 Deep penetration: precipitation
of glycosoaminoglycans &
stromal cell opacification.
PBMA’S H. V. DESAI EYE HOSPITAL

22. SEQUELE:
 Loss of Limbal stem
cells
 Vascularization
 Epithelial defect
 Sterile corneal ulcer
 Perforation
PBMA’S H. V. DESAI EYE HOSPITAL

23. Long term effect:-
- Dry Eyes
- Symblepharon
- Cicatrical Entropion
SEVERE
CONSEQUENCES
- AC penetration
- Iris, damage
- Lens damage
- Hypotony
- Phthisis bulbi
PBMA’S H. V. DESAI EYE HOSPITAL

24. MANAGEMENT
To rescue life.
Immediate treatment aims at preventing further injury or vision loss
Never think of the eye in isolation, always compare both eyes
Always record visual acuity as it has medico legal implications
A visual acuity of 6/6 does not exclude a serious eye injury
Beware of the unilateral red eye as it is rarely ‘just’ conjunctivitis
PBMA’S H. V. DESAI EYE HOSPITAL

25. MANAGEMENT
For all eye injuries:
 DO NOT touch, rub or apply pressure to the eye.
 DO NOT try to remove the object stuck in the eye.
 Do not apply any self medication .
 See a doctor as soon as possible, preferably an ophthalmologist.
For a chemical burn:
 Immediately flush the eye with plenty of clean water.
 Seek emergency medical treatment right away.
PBMA’S H. V. DESAI EYE HOSPITAL

26. MANAGEMENT
For a cut or puncture wound:
 Gently place a shield over the eye, until medical attention is sought.
 DO NOT rinse with water.
 DO NOT remove the object stuck in eye.
 DO NOT rub or apply pressure to eye.
 Avoid aspirin, ibuprofen or other NSAIDS.
 See a physician immediately.
PBMA’S H. V. DESAI EYE HOSPITAL

27. Penetrating Injuries
 Globe perforation
 Corneal tear
 Sclero-corneal tear
 Lens rupture
 Vitreous leak
 Retinal detachment
PBMA’S H. V. DESAI EYE HOSPITAL

28. TREATMENT
 Suturing –
 Corneal, Sclerocorneal tear. (the earlier the better)
 IOL implantation
 Vitrectomy, if needed.
 SOS evisceration, fear of sympathetic ophthalmia.
PBMA’S H. V. DESAI EYE HOSPITAL

29. Superficial foreign body
 Metallic, wooden
 Symptoms:.
 watering,
 irritation,
 pain,
 pricking sensation,
 congestion.
PBMA’S H. V. DESAI EYE HOSPITAL

30. TREATMENT
Foreign body removal with clean
sterile swab
SOS Desmarre’s retractor , fine
forceps disposable needle.
Under tropical anesthesia & slit lamp
examination.
Locally: Antibiotics,
Lubricants,
Eyepatch for 1 day
PBMA’S H. V. DESAI EYE HOSPITAL

31. INTRAOCULAR FOREIGN BODY
PBMA’S H. V. DESAI EYE HOSPITAL

32. MANAGEMENT
 MRI avoided
 CT Scan to be done
 X Rays to bo done
 USG to be done
 Surgical removal
 Removal with magnet
PBMA’S H. V. DESAI EYE HOSPITAL

33. Preventive Measures
 Most eye injuries can be prevented with protective or safety
glasses.
 Wear safety glasses whenever you operate power tools, such as
drills, saws, or power washers; when using a hammer, or when
mixing or spraying chemicals
PBMA’S H. V. DESAI EYE HOSPITAL

34.  Glasses should be:
 well-fitted, durable, protective.
 Eyewear should be with good
visibility.
 There should be strict
compliance on its use.
 Need to review the eyewear
design yearly .
PBMA’S H. V. DESAI EYE HOSPITAL

35.  Welder's goggles or face
masks should be used
when using an arc welder
 Occupational eye safety
programs should be
implemented.
PBMA’S H. V. DESAI EYE HOSPITAL

36. WARNINGBOARDS AND SIGNS
PBMA’S H. V. DESAI EYE HOSPITAL

37. PBMA’S H. V. DESAI EYE HOSPITAL

38. Personal Protective
Equipments
PBMA’S H. V. DESAI EYE HOSPITAL

39. THANK YOU!
PBMA’S H. V. DESAI EYE HOSPITAL