PENETRA TING EYE INJURIES LT COL QAMAR UL ISLAM CLASSIFIED EYE SPEC / ASST PROF AFIO, RAWALPINDI

EPIDEMEOLOGY Ocular trauma is the leading cause of monocular blindness in people < 40 yrs of age Accounts for approx 50% of all ocular emergencies More common in males ( %) Usually occur at workplace (outdoor location )

IMPACT OF OCULAR INJURY Physical disability Social dependency Financial implications

OCULAR TRAUMA MECHANICAL CHEMICALTHERMAL RADIATION TYPES OF OCULAR INJURIES

Mechanical Ocular Trauma Mechanical Ocular Trauma Closed Globe Open Globe Contusion Lamellar Laceration Laceration PenetratingPerforating Rupture

CLASSIFICATION OF OCULAR TRAUMA MECHANICAL EYE INJURIES CLOSED GLOBE INJURIES OPEN GLOBE INJURIES ADNEXAL INJURIES LACERATION (outside-to-inside RUPTURE (Inside-to-outside) CONTU SION LAMELLAR LACERATION SUP F.B PENETRATING INJURY (Entry wound) PERFORATING INJURY (Entry - Exit wound) IOFB

TERMINOLOGIES

CLOSED GLOBE INJURY Blunt trauma Corneoscleral wall intact Intraocular damage

OPEN GLOBE INJURY Full thickness wound of the corneoscleral wall

CONTUSION Closed injury resulting from blunt trauma Damage at site of impact or at a distant site LAMELLAR LACERATION Partial thickness wound caused by sharp object CLOSED GLOBE INJURY

RUPTURE Full thickness wound caused by blunt trauma Globe gives way at the weakest point LACERATION Full thickness wound caused by sharp object At the site of impact OPEN GLOBE INJURY (inside to outside)(outside to inside)

PENETRATION Single full thickness wound without an exit wound Retained intraocular foreign body PERFORATION Two full thickness wounds Entry and exit OPEN GLOBE INJURY

PENETRATING/PERFORATING OCULAR TRAUMA CAUSES : Assault, domestic accident (sharp obj like pen, pencil, scissors, knives, broken spectacles) disposable syringes, sport injuries, windshields of cars in RTA, mine/missile blast injuries, fire arm injuries, chopping or cutting wood, hammering metals or nails

PENETRATING/PERFORATING OCULAR TRAUMA MECH OF INJURY :  Size of object  Speed at the time of impact  Composition of object oSHARP OBJECT well defined laceration of globe oFLYING F.B damage related to their kinetic energy oRETAINED IOFB MECHANICAL EFFECTS INTRODUCTION OF INFECTION TOXIC/CHEMICAL EFECTS

Main Symptoms/Signs Redness of eye, Haemorrages Congestion Lacrimation Photophobia Raised Eyelids Itchy/Watery Eyes Blurring or Loss of Vision Change in Pupil Shape Blood or Fluid Leakage from the Eye Foreign Object Penetrating Eye

Effects Of Penetrating Ocular Injuries Mechanical effects: Laceration of the conjunctiva, corneal lacerations,Vitreous haemorrage, rupture of globe, retinal tears and detachments, scarring which leads to cataract and glaucoma. And Intra ocular foriegn bodies. Introduction of infection: the entrance of the wound may serve as a route of entry for pyogenic bacteria,which may lead to the fromation of abscess of cornea, purulent iridocyclitis or Endophthalmitis Sympathetic Ophthalmitis: It is a complication of penetrating injury. Visual impairment and Enucleation

Effects Of Penetrating Ocular Injuries

* In general always suspect more extensive injury than may be readily apparent and search carefully for any defects in the integrity of the globe or intraocular foreign bodies MANAGEMENT GUIDELINES

Medical Reception Centre Make the patient comfortable Take vital signs Assess the degree of damage Take Visual Acuity Torch examination Distant Direct Ophthalmoscopy Documentation MANAGEMENT GUIDELINES

GENERAL PRINCIPLES Determine the nature and extent of any life-threatening problems History – circumstances, timing, likely object Ocular examination (minimal handling) » Eyes » Orbits Application of eye pad Psychological (avoid negative reassurance !!!!!!!) Referral to eye specialist MANAGEMENT GUIDELINES

Ultrasonography X- Ray Orbit CT SCAN MANAGEMENT GUIDELINES INVESTIGATIONS

PRINCIPLES OF SURGICAL REPAIR PRIMARY REPAIR »Undertaken immediately »Preserve visual acuity »Remove the dead and devitalized tissue »Preserve as much normal tissue as possible »Close any open wounds »Prevent / treat any nidus of infection SECONDARY REPAIR »10 – 14 days after primary repair »Clear opacities of the media »Stabilize abnormal vitreoretinal interactions MANAGEMENT GUIDELINES

Prophylaxis of Endophthalmitis Antibiotics Enucleation (when nothing to salvage) MANAGEMENT GUIDELINES

REMOVAL OF IOFB TECHNIQUE OF REMOVAL OF IOFB depends on : o Chemical composition o Location o Size of IOFB o Clarity of media o Phakic status o Toxicity of IOFB MAGNET removal FORCEPS removal MANAGEMENT GUIDELINES

Don’ts and Do’s DO NOT flush the eye with any liquids other than saline or warm water or even better just do not touch the eye DO NOT remove the object out of the eye DO NOT put any pressure on the eye Do NOT rub your eye. Reassure the person and advise against rubbing or moving their eye as this can cause further damage If the injury is severe, place a moist pad and loosely bandage the eye. Transport the patient to the nearest Hospital as fast as possible In the case of small penetrating objects, use a cup to cover the object and keep the person calm and lying down until help arrives. MANAGEMENT GUIDELINES

TAKE HOME MESSAGE  Anticipation of complications requiring referral to ophthalmic surgeon  The nature and possible consequences of the patient’s condition should be communicated to the patient and his family as accurately and honestly as possible  Never trivialize a condition since untoward complications can make for a very dissatisfied patient and a vulnerable physician

T h a n k y o u IMPACT OF OCULAR INJURY