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In the last classes

1.A common cause of unilateral blindness inchildren and young adults2.1 Eyelid and Lacrimal Trauma

2.2Blunt Trauma 2.2.3Traumatic Iritis

2.2.5Hyphema

2.2.6Traumatic Cataract

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2.3 ocular perforating trauma penetrating wound

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2.4ocular /orbital foreign bodyCorneal / Conjunctival Foreign BodiesIOFBorbital foreign body

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Corneal metallic foreig

body with rust ring

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2.5Chemical burns

Alkali more severe than Acid

Alkali can penetrates through ocular tissues rapidlyand continue to damage

Acid form a barrier of precipitated necrotic tissue

Limit penetration and damage

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How to treat chemical burns?

In the site of injury Tap-water lavageIrrigate away obvious foreign body

In the emergency roomBrief history and examinationIrrigation ocular surfacesconjunctival fornices

Copious irrigation using saline for at least 30 minutesfollowing treatmentCycloplegicTopical antibioticTopical steroidLysis of conjunctival adhesionsamniotic membrane transplant if healing is delayed beyond 2 weeksAscorbate for alkali burns to speed healing time and allow better visual outcome.If any melting of the cornea occurs, Oral tetracyclines may reduce collagenolysis.

In the last classes

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orbit

Chuanbao-Li

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Orbital Disease

1.This section provides a framework toevaluate a variety of orbital diseases

2.Symptoms: Eyelid swelling, bulgingeye(s), and double vision are common.Pain and decreased vision can occur.

3.Critical Signs:Proptosis andrestriction of ocular motility.

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Etiology

Orbital disease can be grouped into 5 types:

Inflammatory: thyroid-related orbitopathyInfectious: orbital cellulitis.Neoplastic: optic nerve glioma, lymphoma.

Trauma: orbital blow-out fracture,Malformation: congenital, vascular, others.

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Work-Up

1.History: Rapid or slow onset? Pain? Fever,systemic symptoms? History of cancer, diabetes,Trauma?2. Vital signs: particularly temperature3.External examination:

Look for nonaxial displacement of the globeTest for resistance to retropulsion by gently

pushing each globe into the orbit.

Feel along the orbital rim for a mass. Check theconjunctival cul-de-sacs carefully and evert theupper eyelid.

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Work-Up

3.External examination: Check extraocular movements. Measure any

ocular misalignment with prisms .To examine for proptosis, Measure with a

Hertel exophthalmometer. Upper limits of normalare approximately 12 - 14 mm . A differencebetween the two eyes of more than 2 mm isconsidered abnormal.

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Work-Up

4.Ocular examination : Specifically check the pupils,visual fields, color vision (by color plates), IOP ,optic nerves, and peripheral retina.5.Imaging studies : Orbital CT or MRI.6. Laboratory tests when appropriate:

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Thyroid-Related Orbitopathy

eyelid retraction and proptosis of the right eye.

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Synonyms: Thyroid Eye Disease or Graves Disease

Ocular SymptomsEarly: nonspecific complaints including foreign bodysensation, redness, tearing, photophobiaLate: eyelid and orbital symptoms includingprominent eyes, persistent eyelid swelling, doublevision, pressure behind the eyes, and decreasedvision in one or both eyes.

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SignsCritical. 1. Retraction of the eyelids (highly specific)2. lagophthalmus. Unilateral or bilateral axialproptosis with resistance to retropulsion.

3 .When extraocular muscles are involved, elevationand abduction are commonly restricted .4. Although often bilateral, unilateral or asymmetricthyroid-related orbitopathy (TRO) is also frequently

seen. Thickening of the extraocular muscles(inferior, medial, superior, and lateral) withoutinvolvement of the associated tendons may benoted on orbital imaging.

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SignsOther. Reduced frequency of blinking (stare),chemosis, significantly elevated intraocular pressure(especially in upgaze), superior limbic

keratoconjunctivitis,etc

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Treatment1. Smoking cessation: All patients with TRO whosmoke must be explicitly told that continuedtobacco use is especially dangerous. Thisconversation should be clearly documented in themedical record. Smokers have a higher incidence of Graves disease and more severe orbitopathy.2. Refer the patient to a medical internist orendocrinologist for management of systemic thyroid

disease, if present.

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Treatment3. Treat exposure keratopathy with artificial tearsand lubricating or by taping eyelids closed at night.4. Treat eyelid edema with cold compresses in themorning and head elevation at night .5. Indications for orbital decompression surgeryinclude: optic nerve compression; worsening orsevere exposure keratopathy despite adequatetreatment (some patients may develop infectiouscorneal ulceration or melting from lagophthalmos);uncontrollable high IOP; or cosmesis.

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Follow-Up1.Optic nerve compression requires immediateattention.2.Patients with advanced exposure keratopathy and

severe proptosis also require prompt attention.3.Patients with minimal to no exposure problemsand mild to moderate proptosis are reevaluatedevery 3 to 6 months. Because of the increased risk

of developing optic neuropathy, patients withrestrictive strabismus should be followed morefrequently.

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Follow-Up4.All patients with TRO are instructed to check forcolor (red) desaturation once every 1 to 2 weeks,and to return immediately with any new visual

problems.

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Orbital Cellulitis

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Orbital Cellulitis

Etiology1. Direct extension from a paranasal sinus infection ordental infection.2. Complication of orbital trauma .

3. Complication of orbital surgery or paranasal sinussurgery (more common).4. Vascular extension (e.g., seeding from a systemicbacteremia )

When a foreign body is retained, the cellulitis maydevelop months after injury.

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Orbital Cellulitis

SymptomsRed eye, pain, blurred vision, double vision, eyelidswelling, nasal congestion, sinus headache, tooth

pain.

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Orbital Cellulitis

SignsCritical. Eyelid edema, tenderness. Conjunctivalchemosis and injection, proptosis, and restrictedocular motility with pain on attempted eyemovement are usually present. Signs of opticneuropathyOther. Decreased vision, optic disc edema, fever.possible orbital abscess.

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Orbital Cellulitis

Treatment1. Admit the patient to the hospital and consultInfectious Disease.

2. Broad-spectrum intravenous (i.v.) antibiotics tocover Gram-positive, Gram-negative, and anaerobicorganisms are required for at least 72 hours,followed by p.o. medication for 1 week.

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Low Vision

Low-vision patients typically have impaired visualperformance, visual acuity not correctable withconventional glasses or contact lenses. They mayhave cloudy vision, constricted fields, or largescotomas.

There may be additional functional complaints:glare sensitivity, abnormal color perception, ordiminished contrast.Some patients have diplopia . A frequent complaint

is confusion from overlapping but dissimilar imagesfrom each eye.

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Low Vision

In the United States, over 6 million persons arevisually impaired but not classified as legally blind.Over 75% of patients seeking treatment are age 65or older.Age-related macular degeneration accounts for anincreasing number of cases. Other common causesof low vision are complicated cataract, cornealdystrophy, glaucoma, diabetic retinopathy, opticatrophy , degenerative myopia, and retinitis

pigmentosa.Approximately 9% of the low-vision population ispediatric, resulting from congenital eye disorders ortrauma.

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Blindness

Blindness: Introductionblindness is a worldwide health problem,

Definition of BlindnessThe World Health Organization (WHO) defines visualimpairment as shown in Table :

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Categories of Visual Impairment

(Adapted from International Classification of Diseases, WHO,1977).

NLP5

lightperception

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Documents

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