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Pedagogical objectives: Peculiarities of management of patients with ocular traumas and eyeburns. Methods of rehabilitation at ocular traumas and burns. The reasons leading to ocular traumas. Main clinical symptoms, differential diagnosis, complications of ocular traumas and burns. First aid at electroophthalmia. The symptoms of “sympathetic” ophthalmia
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TMATMADepartment of eye diseasesDepartment of eye diseases
Medical emergency in ophtalmologyMedical emergency in ophtalmology
The purpose of the training session: Ocular traumas make from 5% to 10% of all eye diseases. Due to this fact the main goal of our lecture is to convince GP in necessity of acquiring knowledge in the questions of etiology, pathogenesis, clinics, diagnostics, treatment and prophylaxis of ocular traumas.
Pedagogical objectives:• Peculiarities of management of patients with ocular traumas and eyeburns.
• Methods of rehabilitation at ocular traumas and burns.• The reasons leading to ocular traumas.• Main clinical symptoms, differential diagnosis, complications of ocular traumas and burns. • First aid at electroophthalmia.
• The symptoms of “sympathetic” ophthalmia
Learning outcomes:The student should know:•Peculiarities of tactics and management of patients with ocular traumas and eye burns
•Methods of rehabilitation at ocular traumas and eye burns
•The reasons leading to ocular traumas and eye burns
•General clinical symptoms, differential diagnosis, complications of ocular traumas and eye burns
•First aid at electroophthalmia • Symptoms of sympathetic ophthalmia
The student should be able to:• Determine tactics in patients with ocular traumas and eye burns•Perform regular examination and treatment of patients with ocular traumas and eye burns• Interpret the results of labs and instrumental methods of examination of patients with ocular traumas and eye burns. • Perform consultations of patients with ocular traumas
• Diagnose of orbital fractures • Differentiate different types of eye burns • Provide fist aid at eye burns
Types of Eye InjuryTypes of Eye Injury
There are a great variety of possible eye injuries but they tend to fit into the following There are a great variety of possible eye injuries but they tend to fit into the following basic types.basic types.
Blunt ocular traumas Blunt ocular traumas Penetrating ocular traumasPenetrating ocular traumas Non-penetrating ocular traumasNon-penetrating ocular traumas Chemical eye injuriesChemical eye injuries Minor superficial eye injuries:Minor superficial eye injuries: corneal abrasionscorneal abrasions corneal and conjunctival foreign bodiescorneal and conjunctival foreign bodies conjunctival lacerations conjunctival lacerations Eyelid injuriesEyelid injuries Orbital injuries and fracturesOrbital injuries and fractures Burns of cornea, conjunctiva and eyelidBurns of cornea, conjunctiva and eyelid
Distribution Distribution
%
26
10
80
Blunt injuries
Burns
Non-penetrating eye injuries
Penetrating eye injuries
Blunt trauma of soft tissues and orbitInjuries are divided by localization:
Blunt traumas of soft tissue and orbit
Closed fractures of orbit
Blunt traumas of soft orbital tissues
Signs:- Subconjunctival haemorrage- Haematoma of eyelids- Absence of ocular movements
Orbital Orbital fracturesfractures
signs:- diplopy- enoftalm-absence of ocular movements
Orbital Orbital fracturesfractures
a) Fractura of medial wall of the eye ( emphyzema of eyelids)b) Fracture of lateral and inferior walls of orbit of right eye с) Fracture of the superior wall of orbit, haematoma of eyelids
а
bc
First-aid tacticsFirst-aid tactics First aid for injuries of surrounding soft
tissues: on-site imposition of cold for 1-2 hours (ice, wet wipes).
Maintaining hemostatic vasoconstrictors (menadione, vitamin K, Ascorutinum calcium chloride 10%).
Immediately send to ophthalmologist.
Divided according to severity:Mild - complete recovery Medium - small residual symptoms do not
affect visual function Severe - there are large morphological
and functional disorders Very severe - Rough morphological
changes, loss of function
Blunt injuries of eye Blunt injuries of eye (contusion)(contusion)
Blunt injuries of the eyeBlunt injuries of the eye
Mechanism of eyeball contusion Mechanism of eyeball contusion ((schematic viewschematic view))
Blunt injuries of the eyeBlunt injuries of the eye
Subconjunctival haemorrage Corneal erosionCorneal erosion Hyphaema Hyphaema Haemophthalm (vitreous haemorrhage)Haemophthalm (vitreous haemorrhage) Iridodonezis (trembling of iris)Iridodonezis (trembling of iris) MydriazisMydriazis Subluxation of lensSubluxation of lens Iridodializis (detachment or tear of the iris)Iridodializis (detachment or tear of the iris) Choroidal or retinal rupturesChoroidal or retinal ruptures Retinal detachmentRetinal detachment Avulsion of an optic nerveAvulsion of an optic nerve
SignsSigns::
Choroidal or retinal rupturesChoroidal or retinal ruptures
Oedema of the cornea and Oedema of the cornea and hyphemahyphema
Ruptura of the pupillaeRuptura of the pupillae
Blunt injuries of the eyeBlunt injuries of the eye
IridodializisIridodializis Dislocation of the lensDislocation of the lens
Blunt injuries of the eyeBlunt injuries of the eye
Choroidal ruptures and Choroidal ruptures and partial haemophthalmospartial haemophthalmos
Choroidal rupturesChoroidal ruptures
Horoidal or retinal rupturesHoroidal or retinal ruptures
Retinal detachmentRetinal detachmentTraumatic avulsion of optic Traumatic avulsion of optic nervenerve
Blunt injuries of the eyeBlunt injuries of the eye
Subconjunctival ruptures of eye
First-aid tacticsFirst-aid tactics Instillation into the conjunctival sac
of antibiotics or sulfa eye drops Anesthesia (local and general) Easy aseptic bandage Immediately send to
ophthalmologist
Injuries of surrounding tissues
Injuries of eyelids
Lacrymal ducts injuries
Foreign bodies
By localization injuries are divided into:
Injuries of eyelids
Lacerative crush wound of lower eyelid Lacerative crush wound
of upper and lower eyelids
Lacrymal ducts injuries
Laceration of the lower eyelid, with injury of lacrimal duct
Foreign bodies of the orbit
Wooden foreign body is located in the right orbit and labyrinth (MRI)
First-aid tacticsFirst-aid tactics Tetanus toxoid Washing the wound with disinfectant
solutions Parenteral (i/m) administration of
antibiotics Easy aseptic bandage Immediately send to
ophthalmologist
Wounds of an eyeballWounds of an eyeball
Divided by localizationDivided by localization::- Corneal woundsCorneal wounds- Scleral woundsScleral wounds- Corneoscleral woundsCorneoscleral wounds- By penetrating of external wallsBy penetrating of external walls- Penetrating injury Penetrating injury - Non-penetrating injury Non-penetrating injury - Penetrating injuries are divided into 2Penetrating injuries are divided into 2::- With intraocular foreign bodyWith intraocular foreign body- With exit of intraocular tissues from the woundWith exit of intraocular tissues from the wound
Wounds of an eyeballWounds of an eyeball
Penetrating injury of cornea, Penetrating injury of cornea, absence of anterior chamberabsence of anterior chamber
Penetrating injury of cornea, Penetrating injury of cornea, anterior chamber is presentanterior chamber is present
Eyeball injuriesEyeball injuries
Penetrating injury of cornea Penetrating injury of cornea with exit of iriswith exit of iris
Penetrating corneaal wound Penetrating corneaal wound complicated with lens complicated with lens opacification opacification
Eyeball woundsEyeball wounds
Penetrating wound of sclera Penetrating wound of sclera with exit of iriswith exit of iris
Corneoscleral penetrating Corneoscleral penetrating injury with foreign bodyinjury with foreign body
Injuries of an eyeballInjuries of an eyeball
Borders of cornea are Borders of cornea are adapted, penetrating wound adapted, penetrating wound with foreign body in anterior with foreign body in anterior
chamberchamber..
Penetrating scleral wound Penetrating scleral wound with foreign bodywith foreign body. .
First-aid tacticsFirst-aid tactics
Tetanus toxoidTetanus toxoid Washing the wound with disinfectant
solutions Parenteral administration of antibiotics Binocular aseptic bandage Immediately send to ophthalmologist
Treatment tacticsTreatment tactics
Performed by ophthalmologist in specialized Performed by ophthalmologist in specialized clinicsclinics::
- X-ray of the orbit in the front and lateral projections
- X-ray of orbit by Komberg – Baltin- Primary surgical treatment of wounds- Reconstructive operations routinely if necessary.
Severe complications after penetrating wounds of the eyeball
Endophthalmitis
Panophthalmitis
Sympathetic ophthalmia
Injuries of eyeballInjuries of eyeball
Thermic and chemic burns of Thermic and chemic burns of eyes eyes
I (mild) degree - redness and swellingII (average) degree – bubblesIII (severe) degree - ischemia and necrotic zoneIV (very severe) degree - necrosis
Burns of eyelids and conjunctiva are Burns of eyelids and conjunctiva are divided by severetydivided by severety
I (mild) degree I (mild) degree – – hyperemia of eye tissues, hyperemia of eye tissues, oedema, superficial corneal erosion. oedema, superficial corneal erosion.
IIII ( (mediummedium) ) degreedegree – – deep corneal erosion, deep corneal erosion, oedema, ishchemisation of conjunctiva and oedema, ishchemisation of conjunctiva and limbus area limbus area
IIIIII ( (severesevere) ) degreedegree – – in addition to the above in addition to the above mentioned corneal opacification like misted mentioned corneal opacification like misted glass in the necrotic zonesglass in the necrotic zones
IVIV ( (very severevery severe) ) degree degree – – porcelain cornea, total porcelain cornea, total necrosis of conjunctiva, perforation necrosis of conjunctiva, perforation
Classification by severetyClassification by severety::
Thermic and chemic burns of Thermic and chemic burns of eyes eyes
Thermic and chemic burns of Thermic and chemic burns of eyes eyes
Конъюнктива ўрта Конъюнктива ўрта даражали кимёвий куйиши. даражали кимёвий куйиши. Лимб сохасида ишемик қон Лимб сохасида ишемик қон
томирсиз зона.томирсиз зона.
Шох парда ўрта даражали Шох парда ўрта даражали кимёвий куйиши. кимёвий куйиши.
Thermic and chemic burns of Thermic and chemic burns of eyes eyes
. . . .
Thermic and chemic burns of Thermic and chemic burns of eyes eyes
Кўз олмаси ўта оғир кимёвий куйиши. Асоратли катаракта шох парда яраси
Кўз олмаси ўта оғир кимёвий куйиши. Асоратли шишган
катаракта, иккиламмчи глаукома.
Thermic and chemic burns of Thermic and chemic burns of eyes eyes
Very severe thermic burnVery severe thermic burn
Thermic and chemic burns of Thermic and chemic burns of eyes eyes
Very severe thermic burn of eyeball and surrounding tissues
Thermic and chemic burns of Thermic and chemic burns of eyes eyes
Very severe thermochemical burns, complicated cataract
Severe theromochemical burn of an eyeball. 1 month after the
injury.
First-aid tacticsFirst-aid tactics Removing of burn agent Washing the conjunctival sac during 10-15 minutes. Using buttered solutions Immediately send to ophthalmologist
In the hospital: Anesthesia Washing of lacrimal ducts The introduction of autologous blood under the
conjunctiva In case of severe burns, tetanus toxoid injection Disinfecting, vitamin solutions Parenteral injection of antibiotics Binocular aseptic bandage
Thermic and chemic burns of Thermic and chemic burns of eyes eyes Енгил ва ўрта даражали куйишларнинг Енгил ва ўрта даражали куйишларнинг
оқибатлари қониқарлиоқибатлари қониқарли Оғир ва ўта оғир даражали куйишлардан Оғир ва ўта оғир даражали куйишлардан
сўнг одатда пластик жаррохликни талаб сўнг одатда пластик жаррохликни талаб қиладиган чандиқли ўзгаришлар қолади.қиладиган чандиқли ўзгаришлар қолади.
Оғир ва ўта оғир даражали куйишлардан Оғир ва ўта оғир даражали куйишлардан сўнги асоратланган болаларни кўз сўнги асоратланган болаларни кўз патологиясини профилактикаси гурухига патологиясини профилактикаси гурухига киритилади ва узоқ муддат актив киритилади ва узоқ муддат актив диспансер назоратида кузатилади.диспансер назоратида кузатилади.
Acute attack of glaucomaAcute attack of glaucoma
Prophylaxis of ocular traumasProphylaxis of ocular traumas
Prevention consists of two stages:The first step, i.e. Primary prevention - preventive measures among the population at home, on the streets, in schools, kindergartens.The second stage, i.e. secondary prevention - early diagnosis, urgent measures to actively integrated medical and surgical treatment to help to prevent dangerous complications such as purulent and phacogenic uveitis, metallosis, hypotension eyeball and sympathetic ophthalmia.
Questions.1. Non-penetrating ocular traumas (contusion). Clinical features, diagnosis, treatment.2. Superficial and deep wounds of eyeball (symptoms, complications, treatment and prevention).3. Thermal and chemical eye burns (Symptoms, complications, treatment and prevention).4. Sympathetic inflammation (clinic, prevention, and treatment)5. Endophthalmitis and panophthalmitis (clinic, prevention and treatment)6. «X-ray» - the localization of foreign bodies in the eye?7. Penetrating and non-penetrating traumas of the posterior segment of the eyeball (hospital treatment)8. Prevention of orbital traumas and the auxiliary apparatus. 9. Electrophthalmia (clinical, prevention, and treatment).10. Prevention of ocular traumas.