1. TRAUMA 1. Eyelid 2. Orbital blow-out fractures
Haematoma
Margin laceration
Canalicular laceration
2. Orbital blow-out fractures
Floor
Medial wall
3. Complications of blunt trauma
Anterior segment
Posterior segment
4. Complications of penetrating trauma
5. Management of intraocular foreign bodies
6. Chemical injuries

2. Eyelid haematoma Usually innocuous but exclude
associated trauma to globe or orbit
Orbital roof fracture if associated with
subconjunctival haemorrhage without
visible posterior limit
Basal skull fracture - bilateral ring
haematomas (‘panda eyes’)

3. Lid margin laceration Carefully align to prevent notching
Align with 6-0 black silk
suture
Close tarsal plate with
fine absorbable suture
Place additional marginal
silk sutures
Close skin with multiple
interrupted 6-0 black
silk sutures

4. Canalicular laceration
Repair within 24 hours
Locate and approximate ends of laceration
Bridge defect with silicone tubing
Leave in situ for about 3 months

5. Pathogenesis of orbital floor blow-out fracture

6. Signs of orbital floor blow-out fracture
Periocular ecchymosis
and oedema
Infraorbital nerve
anaesthesia
Ophthalmoplegia -
typically in up- and down-
gaze (double diplopia)
Enophthalmos - if severe

7. Investigations of orbital floor blow-out fracture
Coronal CT scan
Hess test
Restriction of right upgaze and downgaze
Secondary overaction of left eye
Right blow-out fracture with
‘tear-drop’ sign

8. Surgical treatment of blow-out fractured
(a) Subciliary incision
Coronal CT scan following repair of
right blow-out fracture with synthetic
material
(b) Periosteum elevated and entrapped
orbital contents freed
(c) Defect repaired with synthetic material
(d) Periosteum sutured

9. Medial wall blow-out fracture
Signs
Periorbital subcutaneous emphysema
Ophthalmoplegia - adduction and abduction
if medial rectus muscle is entrapped
Treatment
Release of entrapped tissue
Repair of bony defect

10. Anterior segment complications of blunt trauma
Hyphaema
Iridodialysis
Vossius ring
Sphincter tear
Cataract
Lens subluxation
Angle recession
Rupture of globe

11. Posterior segment complications of blunt trauma
Choroidal rupture and
haemorrhage
Avulsion of vitreous base
and retinal dialysis
Commotio retinae
Equatorial tears
Macular hole
Optic neuropathy

12. Complications of penetrating trauma
Flat anterior chamber
Uveal prolapse
Damage to lens and iris
Vitreous haemorrhage
Tractional retinal detachment
Endophthalmitis

13. Management of intraocular foreign bodies
Localization with reference to radio-
opaque marker
Removal with magnet or by pars plana
vitrectomy

14. Grading of severity of chemical injuries
Grade I (excellent prognosis)
Clear cornea
Limbal ischaemia - nil
Grade II (good prognosis)
Grade III (guarded
prognosis)
Grade IV (very poor
prognosis)
Cornea hazy but visible
iris details
No iris details
Opaque cornea
Limbal ischaemia > 1/2
Limbal ischaemia < 1/3
Limbal ischaemia - 1/3 to 1/2

15. Medical Treatment of Severe Injuries
1. Copious irrigation ( min ) - to restore normal pH
2. Topical steroids ( first 7-10 days ) - to reduce inflammation
3. Topical and systemic ascorbic acid - to enhance collagen production
4. Topical citric acid - to inhibit neutrophil activity
5. Topical and systemic tetracycline - to inhibit collagenase and neutrophil activity

16. Surgical treatment of severe chemical injuries
Division of conjunctival bands
Treatment of corneal opacity by
keratoplasty or keratoprosthesis
Correction of eyelid deformities