1. RED EYE (VISION-THREATENING DISORDERS)
RED EYE and TRAUMA
RED EYE (VISION-THREATENING DISORDERS)
Endophthalmitis
Severe pain
Photophobia
Poor vision
Recent intra-
ocular surgery
This represents the most dreaded complication of intraocular surgery, and usually occurs within a few days or a few weeks after surgery depending upon the organism. Note the rather benign external appearance. The pain and poor vision are the patient’s primary complaints, and the history of surgery clinches the diagnosis.

2. OCULAR TRAUMA Disruption of globe Intraocular foreign bodies Hyphemas
RED EYE and TRAUMA
OCULAR TRAUMA
Disruption of globe
Intraocular foreign bodies
Hyphemas
Orbital wall fractures
Foreign bodies
Corneal abrasions
Complications of blunt trauma
Ocular trauma comes in many forms!

3. RED EYE and TRAUMA
Corneal transparency is a result of the orderliness of the corneal layers. To maintain the proper hydration in the face of positive intraocular pressure, the endothelial cells function as sodium pumps thereby preventing corneal edema.

4. (Complications of blunt trauma)
OCULAR TRAUMA
RED EYE and TRAUMA
(Complications of blunt trauma)
Disruption of globe
Corneal edema is a useful sign in ocular trauma, here indicating a perforating injury due to the gap in the endothelial cell layer allowing aqueous humor to infiltrate the stromal lamellae.

5. Mesquite thorn puncture
RED EYE and TRAUMA
Perforated or not?
Mesquite thorn puncture
Sometimes simple inspection cannot determine if an injury has caused a complete perforation. The Seidel can be useful here.

6. Seidel test: Use concentrated fluorescein
RED EYE and TRAUMA
Seidel test: Use concentrated fluorescein
The fluorescein in most commercial solutions is too dilute to be diagnostically useful. Wet a fluorescein strip instead and apply generous amounts by touching the globe.

7. P0SITIVE SEIDEL Pinpoint perforation Leaking bleb RED EYE and TRAUMA
After applying the fluorescein, observe carefully under the slit lamp for aqueous humor to leak out, diluting the fluorescein as it originates at the site of the lesion and trickles down over the cornea.
Leaking bleb

8. OCULAR TRAUMA The pupil is your clue Perforating trauma
RED EYE and TRAUMA
OCULAR TRAUMA
Perforating trauma
The pupil is your clue
Anterior disruptions of the globe often distort the pupil. If the pupil is displaced or out-of-round, look carefully for a laceration near the limbus.

9. OCULAR TRAUMA Dart puncture with eyelash Perforating trauma
RED EYE and TRAUMA
OCULAR TRAUMA
Perforating trauma
Avoid standing in any position between the throwing arm and the dart board!
Dart puncture with
eyelash

10. Corneal puncture wound with abscess
RED EYE and TRAUMA
Corneal puncture wound with abscess
This eye was struck by a piece of wire at 6 o’clock. The pseudomonus ulcer was responsive only to garamycin.

11. After 3 days of Garamycin Rx
RED EYE and TRAUMA
After 3 days of Garamycin Rx
The appearance suggests significant improvement after 3 days of garamycin therapy, but the clear area in the center of the abscess is extremely thin and in danger of spontaneous rupture.

12. Conjunctival flap RED EYE and TRAUMA
A conjunctival flap brings structural support and healing vascularity to the wound.

13. Three months after flap
RED EYE and TRAUMA
Three months after flap
Success! Vision was 20/30 uncorrected.

14. DISASTER! RED EYE and TRAUMA
This patient suffered blunt trauma and a corneal laceration from 3 to 9 o’clock through which the intraocular contents were extruded. It is obvious that this eye cannot be repaired. What is the next step?

15. OCULAR TRAUMA Intraocular foreign bodies Hyphemas
RED EYE and TRAUMA
OCULAR TRAUMA
Intraocular foreign bodies
Hyphemas
Orbital wall fractures
Foreign bodies
Corneal abrasions
Chemical burns
Corneal lacerations
Finally, we will consider blunt trauma to the eye and it’s consequences.

16. Evaluation of intraocular foreign bodies
RED EYE and TRAUMA
Evaluation of intraocular foreign bodies
Determine visual acuity
Examine for global integrity and degree of damage
Do fundus examination
Place shield over eye
Call ophthalmologist
Remember that intraocular bleeding can rapidly obscure your view.

17. OCULAR TRAUMA Intraocular foreign bodies RED EYE and TRAUMA
The most common source of intraocular foreign bodies is metal hitting metal (hammer and nail).

18. Situation worsening! Poor visibility RED EYE and TRAUMA
Note that the clarity of view has significantly deteriorated in the hour since this patient was originally seen, due to pre-retinal and intra-retinal bleeding. This is the same patient as in the previous fundus view.
Poor visibility

19. Metal fragment RED EYE and TRAUMA
The metallic foreign body was removed.

20. Complications of Blunt Trauma
RED EYE and TRAUMA
Complications of Blunt Trauma
Ruptures of the globe
Hyphema
Blow-out fractures
Retinal tears/detachments
Glaucoma
Cataract
Dislocation of the lens
Damage due to blunt trauma is highly variable and often hidden from obvious view. It is important that all eyes subjected to blunt trauma have a thorough ophthalmoscopic evaluation.

21. OCULAR TRAUMA Hyphemas Rubeosis Hyphema RED EYE and TRAUMA
Most hyphemas will layer out due to gravity. The presence of blood in the anterior chamber is not deleterious by itself but be alert to associated traumatic damage to ocular structures that may have serious long term consequences.
Rubeosis
Hyphema

22. Layered hyphemas RED EYE and TRAUMA
Most partial hyphemas will resorb in 3-7 days. Sometimes the appearance of the hyphema suggests systemic disease, as in the large buffy layer in the eye on the right. The white count was 225,000 and the patient was diagnosed to have acute leukemia.