Ocular Trauma

Sandra M. Brown, MD

Associate Professor

Ophthalmology and Visual Sciences

Nature of Injury

• Blunt

• Lacerating

• Chemical

Blunt Trauma

• Mild – moderate– “bruise” ocular tissues– Eye wall intact

• Moderate – severe– Rupture eye wall– Very severe consequences

Lacerating Trauma

• “cut” eye wall

• Outcome depends on extent and location

Location of Injury

• Anterior Segment

• Posterior Segment

• Adnexa

• Orbital Structures

Anterior Segment

• Conjunctiva

• Cornea

• Iris

• Lens

Posterior Segment

• Vitreous

• Retina

• Optic nerve

Adnexa

• Eyelids

• Lacrimal Structures

Orbital Structures

• Extraocular muscles

• Bony walls

Disgusting Photographs

• Front to back…

Racoon Eye

Lid Laceration

Subconjunctival Hemorrhage

Corneal Foreign Body

Corneal Abrasion

Curling Iron Burn

Corneal Laceration

Iris Sphincter Rupture

Hyphema

Traumatic Cataract

Vitreous Hemorrhage

Retinal Hemorrhage

Optic Disc Hemorrhage

Orbital Wall Fracture

Common Minor Eye Injuries

• Corneal abrasion

• Corneal foreign body

• Chemical splash

• Traumatic iritis

Diagnosis

• History– Sharp vs blunt vs chemical injury

• Exam– CHECK VISION– CHECK VISION– CHECK VISION

Diagnosis cont.

• Exam – Pry lids apart!– Cornea clear?– Pupil round?– Pupil black?– Blood clotted behind cornea?

Diagnosis cont.

• Exam– Red reflex?– Eyes move symmetrically?

Fluorescein Test

• Topical “eye dye”

• COBALT light

Corneal Abrasion

Abrasion Treatment

• Erythromycin ointment

• +/- patch

• 1-2 day follow-up with eye doc

Corneal Foreign Body

Foreign Body Treatment

• Anesthetize eye

• Remove FB– Cotton swab (don’t worsen abrasion!)– Kimura spatula– +/- needle tip

• E-mycin and +/- patch

• 1-2 day follow-up with eye doc

Chemical Splash

Chemical Treatment

• IRRIGATE

• Check pH

• Minor– E-mycin ointment– 1 day follow-up eye doc

• Major– Same day eval by eye doc

Traumatic Iritis

• Moderate blunt injury

• Photophobia

• Lid bruising/edema

• Subconj heme or injection

• Pupil sluggish

• Eval by eye doc

Please Do Not Confuse

• Subconjunctival hemorrhage

• Hyphema