1. Ocular Injury Department of Ophthalmology
Tianjin Medial University General Hospital
Hua Yan, MD, PhD

4. General description The structure of the visual organ
is very fine and weak
Lose the ability to work
Difficulties and sufferings in life
Prompt and right management

5. Classification of ocular injury
Mechanical ocular injury
Contusion
Laceration
Rupture
Non-mechanical ocular injury
ocular chemical burns
thermal burns
radiation damage

6. Classification of mechanical ocular injury
Closed injury
Open injury
Contusion
Laceration
Rupture
Penetrating
IFB
Perforation
Lamellar laceration

7. Mechanical injury of the eye
Make up more than 80% of the total injuries
metal fragment,
instruments in work,
knife,
scissors,
needle,
pliers,
shells,
ears of wheat and grain,
spots instruments,
toys at home,
explosive flying stone,
iron piece,
shell fragment in battlefield

8. Mechanical injury of the eye
Take place
young workers
students
youth
people short of experience in work

9. Orbital Injury

10. Orbital injury - clinical findings
Fracture of orbital wall and nearby cranial bone, nasal sinuses and optic canal (leading to optic nerve atrophy)
Fracture of the ethmoid sinus (subcutaneous emphysema)
Injuries of the eyelids, the globe and deep soft tissue of the orbit (orbital cellulitis)
Intraorbital hemorrhage may induce exophthalmos and palpebral ecchymoma

11. Orbital injury - treatment
Complications of nervous or systemic system - management
Closed simple fracture of the orbital bony rim - no special treatment
Severe injury of skull, reflex of the pupil should be examined
Severe injury of soft tissue - debridement and suturing layer, TAT and antibiotic
Large foreign body in the orbit should be extracted as early as possible
Small and deep ones, generally extractive operation isn’t needed.
Intraobital hemorrhage - pressure bandage

12. Palpebral injury

13. Palpebral injury - clinical findings
Palpebral skin is thin and loose, it is quite easy to be healed after injury and the infection is rare
Palpebral swelling and hemorrhage
Subconjunctival hemorrhage may spread into the subcutaneous tissue of another eye through the nose bridge
Breakdown of the palpebral margin
Breaking of ligaments of the inner and outer canthi

14. Palpebral injury - treatment
The palpebral edema and hemorrhage may be absorbed spontaneously
Fresh wound must be debridement and sutured as early as possible
Tetanus antitoxin (TAT)
Antibiotic

15. Conjunctival foreign body - clinical findings
Dust, coal dust and small insect
Most of the foreign bodies are pushed into the inferior tarsal sulcus of the upper eyelid
Foreign body sensation, pain, tearing, and palpebral spasm
Conjunctival hyperemia
Eyelid is everted, fine foreign body often lodges in the lower tarsal sulcus of the conjunctiva in the upper eyelid

16. Conjunctival foreign body - treatment
Removed by wet cotton roll or clean towel

17. Corneal foreign body

18. Corneal foreign body - etiology
Metal pieces
Dust in atmosphere
Insects
Husks
Explosive injury

19. Corneal foreign body - clinical findings
Foreign body sensation
Pain
Photophobia
Tearing
Palpebral spasm

20. Corneal foreign body - treatment
Don’t rub the eye
Remove with cotton-tipped applicator after surface anesthesia with 0.5%-1% dicaine solution
After several hours of existing, an iron pieces arouses siderosis on its surrounding tissue
Rust is difficult to be removed clearly

21. Penetrating injury
of the globe

22. Penetrating injury of the globe
Beat something with a hammer, splashing pieces to eye
The severity of penetrating injury is related to many factors
Size
Shape
Character of instruments causing trauma
Splashing velocity
Injured site
Polluted degree

23. Penetrating injury of the globe – clinical findings
Direct damage to ocular tissue
Corneal penetrating injury
Prolapse of intraocular contents
Secondary glaucoma
Traumatic cataract
Intraocular hemorrhage

24. Severity of penetrating injury
Endophthalmitis---Intraocular infection
Intraocular foreign body
Inflammatory reaction
Metal foreign body may harm intraocular tissue
Sympathetic ophthalmia
Sometimes penetrating injury or intraocular foreign body in one eye leads to severe uveitis in another eye which is called sympathetic ophthalmia

25. Penetrating injury of the globe - treatment
Don’t squeeze injured eye on examination
Emergency treatment
clean the wound
instill antibiotic ointment and bandage both eyes
transmit the wounded to hospital in time
tetanus antitoxin
Corneal, scleral wound should be sutured as early as possible
As for corneal or scleral wound with prolapse of the uvea, if it is within 24 hours, the wound is clean, the prolapsed tissue may be replaced into the eye

26. Penetrating injury of the globe - treatment
In order to prevent iris incarceration, injection of air into the anterior chamber should be done
For the corneal line wound which is less than 3mm with no incarceration, the anterior chamber is restored all or partially, suture isn’t needed
Minor and closed scleral wound needn’t be sutured
Inject antibody into subconjunctiva
Examination next day

27. Intraocular foreign body

28. Intraocular foreign body
Commonly occurred in eye injury
Steel, iron, copper, non – metal foreign body
In the anterior chamber, lens, vitreous, incarcerated in the retinal and uvea
Stable substance such as gold, silver, glass, stone and etc may lead to simple exudative reaction surrounding the foreign body
Steel and iron within the eye bring about severe reaction

29. Intraocular foreign body - diagnosis
Injury history
Signs
Ocular examination
X ray CT

30. Preoperative examinations
Visual acuity
Slit lamp examination
Direct and indirect Ophthalmoscopy (mydriatic)
B-scan

33. Intraocular foreign body - treatment
Magnetic IOFB
In the anterior chamber
In the lens
In the posterior part of the globe
Non–magnetic IOFB

40. Review Classification of ocular injury ?
Harm of penetrating injury of the globe ?
Treatment of penetrating injury of the globe ?