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Random Trauma Tips

7-14-10

 jshum

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Eye Anatomy

Sclera

Choroid

Retina

Cornea

Iris

Pupil

Lens

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Orbital Architecture

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Location of Injury

• Anterior Segment

• Posterior Segment

•

Adnexa• Orbital Structures

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Anterior Segment

• Conjunctiva

• Cornea

•

Iris• Lens

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Posterior Segment

• Vitreous

• Retina

•

Optic nerve

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Adnexa

• Eyelids

• Lacrimal Structures

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Orbital Structures

• Extraocular muscles

• Bony walls

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Common Minor Eye Injuries

• Corneal abrasion

• Corneal foreign body

•

Hyphema• Traumatic iritis

• Bleeding

• Lacerations

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Penetrating Trauma

• Lid injuries 

 – Moderate pressure control bleeding

 – Cover with moist dressing

 – Should be seen by ophthalmologist

• Lacerations of inner one-third of lid may damage tear-

duct system

• Lacerations involving lid margins may cause notching

• Horizontal lacerations may damage levator muscle

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Penetrating Trauma

• Globe Laceration 

 – Dark spots or streaks on sclera

 – “Jelly-like” material on eye or face 

If in doubt, assume trauma toorbital area involves globe

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Penetrating Trauma

• Globe Laceration 

 –

Cover with moist sterile dressings – NO pressure

 – Cover both eyes

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Subconjunctival Hemorrhage

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Subconjunctival Hemorrhages• Definition

• Symptoms

• Signs

• Complete exam

• Treatment

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Blunt Trauma

• Subconjunctival hemorrhage  – Bruised eye

 –

Blood between conjunctiva and sclera; stops at margin of cornea

 – No emergency

 – Heals like any other bruise

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Blunt Trauma

• Hyphema

 – Blood in anterior chamber

 – First bleed usually

disappears rapidly

 – Second bleed more severe;

fills entire anterior chamber

 – Increased intraocular

pressure can cause

blindness

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Hyphema- Presentation• Definition

• Symptoms

• Grading

• 0 RBC’s 

• I <1/3

• II 1/3 – 1/2 

• III > 1/2

• IV eight ball

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Hyphema- Management

• Ophthalmic consult

• Pupillary play/Eye Patch

• Reverse Trendelenburg

• Anesthesia /Anti-emetic

• IOP control > 30 mmHg (>24 mmHg in HbSS)

• Admission• HbSS

• Anti-coagulated

• > Grade I

• Decreasing VA

• ED evaluation > 1 day after initial injury.• Complications

• Re-bleed

• Post-traumatic glaucoma

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Iritis- Presentation• Definition

• Symptoms

• Photophobia

• Eye pain

• Signs• Limbus injection

• Miosis

• Mydriasis

• VA

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Iritis – Management• Complete Examination.

• Cycloplegic

• NSAIDS

• Sunglasses

• No antibiotics

• Topical steroids?

• Follow-Up

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Foreign Body

• Extraocular foreign body 

 – Object on conjunctiva or cornea

• Intraocular foreign body

 – Object has penetrated cornea or sclera

• Contact lenses 

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Corneal Foreign Body

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Fluorescein Test

• Topical “eye dye” 

• COBALT light

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Corneal Abrasion

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Corneal Abrasions

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Abrasion Treatment

• Erythromycin ointment

• +/- patch

• 1-2 day follow-up with eye doc

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Retrobulbar Hemorrhage - Presentation

• Definition

• Symptoms

• Critical signs

• Proptosis

• Visual acuity• Marcus-Gunn pupil

• Red desaturation

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Retrobulbar Hemorrhage-

Management• “TIME IS RETINA” 

• Progressive

• Lateral canthotomy

• CT scan of orbit

• Disposition