Ocular Trauma Sandra M. Brown, MD Associate Professor Ophthalmology and Visual Sciences

Nature of Injury Blunt Lacerating Chemical

Blunt Trauma Mild – moderate –“bruise” ocular tissues –Eye wall intact Moderate – severe –Rupture eye wall –Very severe consequences

Lacerating Trauma “cut” eye wall Outcome depends on extent and location

Location of Injury Anterior Segment Posterior Segment Adnexa Orbital Structures

Anterior Segment Conjunctiva Cornea Iris Lens

Posterior Segment Vitreous Retina Optic nerve

Adnexa Eyelids Lacrimal Structures

Orbital Structures Extraocular muscles Bony walls

Disgusting Photographs Front to back…

Racoon Eye

Lid Laceration

Subconjunctival Hemorrhage

Corneal Foreign Body

Corneal Abrasion

Curling Iron Burn

Corneal Laceration

Iris Sphincter Rupture

Hyphema

Traumatic Cataract

Vitreous Hemorrhage

Retinal Hemorrhage

Optic Disc Hemorrhage

Orbital Wall Fracture

Common Minor Eye Injuries Corneal abrasion Corneal foreign body Chemical splash Traumatic iritis

Diagnosis History –Sharp vs blunt vs chemical injury Exam –CHECK VISION

Diagnosis cont. Exam – Pry lids apart! –Cornea clear? –Pupil round? –Pupil black? –Blood clotted behind cornea?

Diagnosis cont. Exam –Red reflex? –Eyes move symmetrically?

Fluorescein Test Topical “eye dye” COBALT light

Corneal Abrasion

Abrasion Treatment Erythromycin ointment +/- patch 1-2 day follow-up with eye doc

Corneal Foreign Body

Foreign Body Treatment Anesthetize eye Remove FB –Cotton swab (don’t worsen abrasion!) –Kimura spatula –+/- needle tip E-mycin and +/- patch 1-2 day follow-up with eye doc

Chemical Splash

Chemical Treatment IRRIGATE Check pH Minor –E-mycin ointment –1 day follow-up eye doc Major –Same day eval by eye doc

Traumatic Iritis Moderate blunt injury Photophobia Lid bruising/edema Subconj heme or injection Pupil sluggish Eval by eye doc

Please Do Not Confuse Subconjunctival hemorrhage Hyphema