🔹
Periocular Hematoma:
A"black eye', consisting of a haematoma(focal collection of blood) and/or periocular ecchymosis(diffuse
bruising) and oedema, is the most common blunt injury to the eyelid or forehead and is generally innocuous.
🔹
It is,however,critical to excude associated globe, orbit, and base of the skull injuries.
Bilateral perioculor haematomas (panda eyes) can be a
🔹
sign of a skull base fracture.
“Ungent imaging such as computed tomogrophy(CT),manetic resonance imaging(MRI) should be
🔹blunt trauma with Subconjunctival hemorrhage with no posterior limit in anterior fossa fracture
conidered if there suspicion of an underlying injury to the eyeball or orbit
LID Lid Laceration
The presence of a lid laceration, however insignificant, mandates
careful exploration of the wound and examination of the globe
and adnexal structures.
alkali burns are twice as common as acid burns since alkalis are 🔹
Any lid defect should be repaired by direct closure whenever possible.
🔹 Horizontal superficial: direct closure (6-0 silk)
more widely used both at home and in industry. The severity of a
chemical injury is related to the properties of the chemical, the 🔹
🔹
Mild tissue loss <30%: Canthdlysis
severe tissue loss:graft reconstruction.
Lid margin lacerations invariably gape without careful closure and to prevent notching must be sutured
area of affected ocular surface, duration of exposure.
Alkalis tend to penetrate more deeply than acids as the latter
coagulate surface proteins,forming a protective barrier. 🔹
with optimal alignment
canalicular lacerations should be repaired within 24 hours
the laceration is bridged by silicone tubing which is threaded down the lacrimal system and tied in the
The most commoniy involved alkalis are ammonia, sodium
hydroxide and lime. nose,following which the laceration is sutured.
-Ammonia and sodium hydroxide
Characteristically produce severe damage because of rapid
🔹
penetration.
Pathophysiology:
-necrosis of epith ,limbal ischemia loss os stem cells loss of goblet
Globe rupture
Rupture of the globe may result from severe blunt trauma The prognosis is poor if the initial visual level
🔹
cells symblepharon is light perception or worse.
-AC: iris ND lens damage The rupture is usually anterior(coneal, scleral or sclerocorneal ) with prolapse of structures such as
-ciliary epithelium damage: hyptony & phthisis bulbi CHEMICAE INJURIES the lens iris,ciliary body and vitreous.
🔹
-deeper: storml corneal opacification An anterior rupture may be masked by extensive subconjunctival haemorhage. Rupture at the site of a
🔹
Grading: surgical wound (e.g.cataract, keratopiasty, vitrectomy)commonly follows substantial blunt force.
Grade1: clear cornea, no limbal ischemia. An occult posterior rupture can be associated with little visible
Grade2: hazy cornea, limbal ischemia<1/3 damage to the anterior segment, but should be suspected if there
Grade3: no iris details, limbal ischemia 1/3-1/2 is asymmetry of anterior chamber depth.
Grade4: opaque cornea limbal ischemia >1/2 The anterior chamber of an affected eye is classically deep,with posterior rotation of the iris-lens
🔹 Treatment (Emergency):
- irrigation (normal saline or RL up to 30 minutes till PH is
diaphragm and IOP in the affected eye is low.
The rupture is often found slightly behind the insertion of the rectus muscles where the sclera is thinnest.
normalized)
-tap water by first person 🔹 Vitreous haemorrhage
Vitreous haemorrhage may occur,commonly in association with posterior
-evert the lid
-debridement of necrotic cornea epithelium . vitreous detachment.
Pigment cells (tobacco dust')can be seen floating in the anterior vitreous and
though not necessarily associated with a retinal break, should always prompt
careful retinal assessment.
🔹 Diagnosis:
-visual function, especially acuity, should be recorded and monitored.
🔹 Commotio etinae (Berlin’s edema)
Commotioretinae is'caused by concussion of the sensory retina
-periocular signs include variable ecchymosis,oedema
resulting in cloudy swelling that gives the involved area a gray appearance.
-Infraorbital nerve anaesthesia involving the lowerlid, cheek,
It most frequently affects the temporal fundus. if the macula is involved, a'cherry-red spot'
side of nose, upper lip, upper teeth and gums is common
may be seen at the fovea severe involvement may be associated With intraretinal
-Diplopia may be caused by one of the following mechanisms:
•hemorrhage and oedema in the orbit may cause tightening of the septa connecting the Globe haemorrhage that can involve the macula.
The prognosis in mid cases is good with spontaneous resolution in around 6 weeks
inferior rectus and inferior oblique muscles to the periorbita thus restricting movement
-Severe commotio may result in progressive pigmentary degeneration and macular hole
of the globe ocular motility usually improves as the haemorrhage and oedema resolve.
formation
Diplopia typically occurs in both upgaze and downgaze.
🔹Choroidal rupture
•direct injury to an extraocular muscle. The musclefibres usually regenerate and normal
function often returns within about 2 months.
-Enophthalmos may be present if the fracture is severe,although Choroidal rupture involves the choroid, Bruch membrane and retinal pigment epithelium.
it tends to manifest only after a few days as initial oedema resolve Orbital Floor Fracture It may be direct or indirect.
-Ocular damage (eg. hyphaema, angle recession, retinal a blow out fracure of the orbital floor is typically caused by a sudden -Direct ruptures are located anteriorly at the site of impact and run parallel with the ora
dialysis)should beexcluded bycarefullexamination of the globe. increase in the orbital pressure from an impacting object that is geater in serrata
-CT with coronal sections aids in evaluation of the extent of a fracure and diameter than the orbital aperture(about 5cm),such as a fist or a tennis ball -Indirect ruptures occur opposite the site of impact. Afresh rupture may be partially
determination of the nature of maxillary antral soft-tissue densties, which may so that the eyeball itself displaced and transmits rather than absorbs the obscured by subretinal hemorrhage, which may break through the internal limiting
represent prolapsed orbital fat, extraocular muscles, haematoma or unrelated antral impact Since the bones of the lateral wall and the roof reusualyable to membrane with resultant subhyaloid or vitreous haemorrhage
polyps. withstand such trauma, the fracture most frequently involves the floor of Weeks to months later, on absorption of the blood, a white
the orbit along the thin bone covering the infraorbital canal. Occasionally, crescentic vetical streak of exposed underying sclera concentrnic With the optic disc
the medial orbital wall may also be fractured becomes visible.
Treatment the visual prognosis poor if the fovea is invoved
-Initial treatment generally consists of observation, with the prescription of
oral antibiotics lce packs and nasal decongestants may be helpful the patient
should be instructed not to blow his nose, because of the possibility of forcing 🔹Retinal breaks and detachment
infected sinus contents into the orbit. Posterior segment blunt trauma is responsible for about 10 percent of all cases of retinal detachment (RD)
and is the most common cause in children.
-subsequent surgical treatment is aimed at the prevention of permanent
trauma
Vertical diplopia and/or cosmetically unacceptable enophthalmos.
EYE 🔹retinal dialysis is a break occurring at the ora serrata
Blow-out medial wall fracture
Medial wall orbital fractures are usually associated with floor fracures
TRAUMA 🔹 Giant break are less frequent and are due to direct retinal disruption at the
point of sclera impact
it is uncommon to find an isolated fracture of the medial wall
Signs -RD secondary to a giant tear may occasionally be seen
include periorbital ecchymosis and frequently subcutaneous
emphysema, which typically develops on blowing the nose. Traumatic optic neuropathy
defecive ocular motility involving abduction and adduction is present if traumatic optic neuropathy follow ocular orbital ocular orbital or head trauma and presents with
the medial rectus muscle is entrapped Eye traumacan be divided into: sudden visual loss that can't be explained by other ocular pathology (RAPD in the only finding)
Diagnosis
-Globe injuries
-Lid injuries
-Orbit injuries
🔹
it occurs in up to 5 percent of facial fractures.
Classification
•direct, due to blunt or sharp optic nerve damage from agents such as displaced bony fragments,
"Proptosis, eyelid oedema and ecchymosis,haemorrhagic chemosis
ocular motility dysfunction, decrease visual acuity, elevated pupillary a projectile, or local haematoma.
defect are among the possible signs Orbital haemorrhage •indirect,(morecommon) in which force istransmitted secondarily to the nerve without apparent
orbital (retrobulbar) haemorrhage is important chiefly due to the direct disruption due to impactsupon the eye, orbit or other cranial structures
🔹
associated risk of acute orbital compartment syndrome with
Treatment compressive optic neuropathy and can
Treatment should be started immediately if progressive visual Treatment.
lead to irreversible blindness of the affected eye in severe cases Spontaneous visual improvement occurs in up to about half of patient with indirect injury however
deterioration occurs. Canthotomy alone is rarely adequate. iatrogenic orbital haemorrhage in not uncommon typically if there is initially no light perception the prognosis is poor.
resulting from a period or retrobulbar local anaesthetic block Several treatment options have been advocated but no clear benefit has been shown and all carry
•canthotomy: After clamping the incision site for 60 seconds, scissors performed to facilitate intraocular
are used to make a1-2cm horizontal full thickness incision under local significant risks..
surgery.
Anastasia at the lateral canthus
•cantolysis: Following canthotomy, the lower lid is retracted downward
and the inferior crus of the lateral canthal tendon
🔹 Abusive head trauma
abusive head trauma('shaken baby'syndrome)is aform of
physical abuse occuring typically in children under the age of 2 years.
Blunt Trauma The pattern of injury results from rotational acceleration and deceleration of
The most common causes of blunt trauma are sporting injuries the head, in contrast to the linear forces generated by a fall.
and assault, Severe blunt trauma to the globe results in anteroposterior presentation is frequenty with iritability, lethargy and vomiting which may be
compression with simutaneous expansion in the initially misdiagnosed as gastroenteritis
equatorial plane ofen associated with a transient but sever increase in IOP.
Athough the impact is primarly absorbed by the lens-iris diaphragm and the 🔹
other infecion because the History of injury is with held.
ocular features -
•Retinal haemorhages
vitreous base,damage can also occur to the posterior pole. The extent of
Ocular damage depends on the severity of trauma. The prognosis varies, but •Periocular bruising and subconiunctival haemorrhage.
is usually detemined by the extent of the retinal injury •Poor visual responses and afferent pupilary defect
by fatema okoff
🔹
cornea
corneal abrasion involves abreach of the epithelium and stains with flourescein if located
over the pupillary area,vision maybe signifilcantly impaired
Penetrating injuries are three times more common in males
than females and typically occur in a younger age group(50%
🔹 Acute corneal oedema may develop following blunt trauma, secondary to focal or diffuse
aged 15-34) the most frequent causes are assault
domestic\occupational accidents and sport.
dysfunction of the endothelium.and is sometimes seen underiying aiarge abrasion.
🔹 Tears in Descemet membrane are usually vertical and most commonly arise as the result of 🔷 Corneal
birth trauma Peaking of the pupil and shallowing ofthe anterior chamber
are key signs, though full thickness corneal penetration may
ORBIT 🔹
be present without these signs.
surgical rules:
-meticulous water-tight re-approximation of the wound without
incarceration (10/0nylon sutures)
-accessible, non self-sealing wound must be closed.
-Non viable prolapsed tissue or neglected :excised
-Viable prolapsed tissue: reposted
🔹 -prevent & treat secondary complication
🔹
Hyphaema -remove IOFB - control bleeding
🔹
Management of hyphema Hyphaema(haemorrhage in the anteriorchamber) is a common complication of blunt complications.
🔹 hospitalization if restless patient or large ocular injury. The source "of bleeding is typically the iris root or ciliary body face. -glaucoma: med ttt or surgery.
🔹 bed rest Characteristicaily, the blood settles inferiorly with a resultant fluid level except when -Ghost cell glaucoma: vitrectromy
🔹 cycloplegia topical steroid no aspirin products the hyphaema is total. -endophthalmitis: Antibiotics.
🔹 anti glaucoma (>40mmhg, 20 mmhg for 2 weeks) Uncontrolled high IOP can result in ischemic optic neuropathy and staining of the -Intraocular inflammation: steroids, cycloplegics.
anti fibrinolytic (aminocaproic acid, tranexamic acid) cornea. -Retained IOFB: removal.
-vetrous haemorrhage
surgical evacuation of hyphema: Scleral wounds
evacuation of hyphema anterior wounds are of better prognosis than the posterior
-IOP>50 mmHg for 5days wounds (occult wounds, what are the signs?)
-IOP> 35 mmHg for 7 days primary repair ofthe sclera using 7-0 absorbable sutures to
-IOP>25 mmHg for 1 day + sickle cell disease, glaucoma patient or total restore globe integrity should betheinitial priority
hyphema. Penetrating trauma
🔷
- corneal blood staining
- first sign regardless of IOP Superficial foreign body
- prolonged clot A small foreign body,such as a particle of steel,coalors and, often
- total hyphema >5 days impacts on the corneal or conjunctival surface This may be washed
- smaller hyphema >10 days along the tear film into the lacrimal drainage system or adhere to the
superior tarsal conjunctiva and abrade the cornea with every blink,When
🔹 pupil:
•The iris may momentarily be compressed against the anterior surface of the lens by
apathognomonic patten of linear corneal abrasion may be seen
A high index of suspicion should be maintained for the presence of an
IOFB posterior segment examination and if necessary plain X-ray
severe anteroposterior force, with resultant imprinting of pigment from the pupillary imaging can be used to help to exclude this
margin. Transient miosis accompanies the compression, evidenced by the pattern of If a coneal foreign body is not removed,there is a significant risk of
pigment corresponding to the size of the constricted pupil (vossius ring) secondary infection and cornea luiceration
•Damage to the iris sphincter may result in traumatic
mydriasis, which can be temporary or permanent.
The pupil tear reacts sluggishly or notat allito bothlight and accommodation. Radial
tears in the pupillary margin are common.
🔷 intaocular foreign body
An IOFB maytraumatize the eye mechanically, introduce
Iris infection or exert other toxic effects on the intraocular
🔹 Iridodialysis is a dehiscence of the iris from the ciliary body at its root.
The pupil is typically D-shaped and the dialysis is seen as a dark biconvex area
structures. it may lodge in any of the structures it
encounters,thus may be located anywhere in the anterior or
posterior segments.Notable mechanical effects
near the limbus indlude_cataract formation"secondary"to capsular injury,
-An iridodialysis may be asymptomatic if it is covered by upper lid. However, vitreous liquefaction and retinaihaemorrhages and tears. Many
monocular diplopia and glare sometimes ensue if the dehiscence is exposed in substances are inert,including glass, blastics, gold and
the palpebral aperture. silver.
Traumatic aniridia(360 iridodialysis) is rare. however iron and copper may undergo dissociation and result in
-In pseudophakic eye, the detached iris may be ejected through the cataract
surgical incision. 🔹
siderosis and chalcosis respectively.
diagnosis:
🔹
-History: revolving machines, hammering.
Cataract formation is a common sequel to blunt -Site of entry fluorescein stain
trauma. -Small, fast, sharp: no detectable entry sit
Postulated mechanisms include direct damage to the -localized cataract.
lens fibres themseives and minute ruptures in the lens -gonioscopy and fundoscopy
with an influx of aqueous humour, hydration of lens -intraocular inflammation:
fibres and consequent opacification. -CT scan is of choice
-MRI contraindicated if metallic FB is suspected
🔹 -X-ray
🔹
subluxation of the lens may occur, secondary to tearing of he
suspensory ligament. The anterior chamber may deepen over the area of surgical management
zonular dehiscence if the lens rotates posteriorly. The edge of subluxated IOFB removal by magnet or vitrectomy using forceps
lens may be seen. Lens intravital AB as prophylaxis of endophthalmitis
trembling of the iris (iridodonesis) orlens (phakodonesis) may be seen on
ocular movement. Subluxation of magnitude sufficient to render the pupil
partly aphakic may result in uniocular diplopia
🔹 dislocation due to 360 rupture of the zonular fibres is rare.
the lens may dislocate into the vitreous orinto the anterior
chamber.
Periocular Hematoma:
A"black eye', consisting of a haematoma(focal collection of blood) and/or periocular ecchymosis(diffuse
bruising) and oedema, is the most common blunt injury to the eyelid or forehead and is generally innocuous.
🔹
It is,however,critical to excude associated globe, orbit, and base of the skull injuries.
Bilateral perioculor haematomas (panda eyes) can be a
🔹
sign of a skull base fracture.
“Ungent imaging such as computed tomogrophy(CT),manetic resonance imaging(MRI) should be
🔹blunt trauma with Subconjunctival hemorrhage with no posterior limit in anterior fossa fracture
conidered if there suspicion of an underlying injury to the eyeball or orbit
LID Lid Laceration
The presence of a lid laceration, however insignificant, mandates
careful exploration of the wound and examination of the globe
and adnexal structures.
alkali burns are twice as common as acid burns since alkalis are 🔹
Any lid defect should be repaired by direct closure whenever possible.
🔹 Horizontal superficial: direct closure (6-0 silk)
more widely used both at home and in industry. The severity of a
chemical injury is related to the properties of the chemical, the 🔹
🔹
Mild tissue loss <30%: Canthdlysis
severe tissue loss:graft reconstruction.
Lid margin lacerations invariably gape without careful closure and to prevent notching must be sutured
area of affected ocular surface, duration of exposure.
Alkalis tend to penetrate more deeply than acids as the latter
coagulate surface proteins,forming a protective barrier. 🔹
with optimal alignment
canalicular lacerations should be repaired within 24 hours
the laceration is bridged by silicone tubing which is threaded down the lacrimal system and tied in the
The most commoniy involved alkalis are ammonia, sodium
hydroxide and lime. nose,following which the laceration is sutured.
-Ammonia and sodium hydroxide
Characteristically produce severe damage because of rapid
🔹
penetration.
Pathophysiology:
-necrosis of epith ,limbal ischemia loss os stem cells loss of goblet
Globe rupture
Rupture of the globe may result from severe blunt trauma The prognosis is poor if the initial visual level
🔹
cells symblepharon is light perception or worse.
-AC: iris ND lens damage The rupture is usually anterior(coneal, scleral or sclerocorneal ) with prolapse of structures such as
-ciliary epithelium damage: hyptony & phthisis bulbi CHEMICAE INJURIES the lens iris,ciliary body and vitreous.
🔹
-deeper: storml corneal opacification An anterior rupture may be masked by extensive subconjunctival haemorhage. Rupture at the site of a
🔹
Grading: surgical wound (e.g.cataract, keratopiasty, vitrectomy)commonly follows substantial blunt force.
Grade1: clear cornea, no limbal ischemia. An occult posterior rupture can be associated with little visible
Grade2: hazy cornea, limbal ischemia<1/3 damage to the anterior segment, but should be suspected if there
Grade3: no iris details, limbal ischemia 1/3-1/2 is asymmetry of anterior chamber depth.
Grade4: opaque cornea limbal ischemia >1/2 The anterior chamber of an affected eye is classically deep,with posterior rotation of the iris-lens
🔹 Treatment (Emergency):
- irrigation (normal saline or RL up to 30 minutes till PH is
diaphragm and IOP in the affected eye is low.
The rupture is often found slightly behind the insertion of the rectus muscles where the sclera is thinnest.
normalized)
-tap water by first person 🔹 Vitreous haemorrhage
Vitreous haemorrhage may occur,commonly in association with posterior
-evert the lid
-debridement of necrotic cornea epithelium . vitreous detachment.
Pigment cells (tobacco dust')can be seen floating in the anterior vitreous and
though not necessarily associated with a retinal break, should always prompt
careful retinal assessment.
🔹 Diagnosis:
-visual function, especially acuity, should be recorded and monitored.
🔹 Commotio etinae (Berlin’s edema)
Commotioretinae is'caused by concussion of the sensory retina
-periocular signs include variable ecchymosis,oedema
resulting in cloudy swelling that gives the involved area a gray appearance.
-Infraorbital nerve anaesthesia involving the lowerlid, cheek,
It most frequently affects the temporal fundus. if the macula is involved, a'cherry-red spot'
side of nose, upper lip, upper teeth and gums is common
may be seen at the fovea severe involvement may be associated With intraretinal
-Diplopia may be caused by one of the following mechanisms:
•hemorrhage and oedema in the orbit may cause tightening of the septa connecting the Globe haemorrhage that can involve the macula.
The prognosis in mid cases is good with spontaneous resolution in around 6 weeks
inferior rectus and inferior oblique muscles to the periorbita thus restricting movement
-Severe commotio may result in progressive pigmentary degeneration and macular hole
of the globe ocular motility usually improves as the haemorrhage and oedema resolve.
formation
Diplopia typically occurs in both upgaze and downgaze.
🔹Choroidal rupture
•direct injury to an extraocular muscle. The musclefibres usually regenerate and normal
function often returns within about 2 months.
-Enophthalmos may be present if the fracture is severe,although Choroidal rupture involves the choroid, Bruch membrane and retinal pigment epithelium.
it tends to manifest only after a few days as initial oedema resolve Orbital Floor Fracture It may be direct or indirect.
-Ocular damage (eg. hyphaema, angle recession, retinal a blow out fracure of the orbital floor is typically caused by a sudden -Direct ruptures are located anteriorly at the site of impact and run parallel with the ora
dialysis)should beexcluded bycarefullexamination of the globe. increase in the orbital pressure from an impacting object that is geater in serrata
-CT with coronal sections aids in evaluation of the extent of a fracure and diameter than the orbital aperture(about 5cm),such as a fist or a tennis ball -Indirect ruptures occur opposite the site of impact. Afresh rupture may be partially
determination of the nature of maxillary antral soft-tissue densties, which may so that the eyeball itself displaced and transmits rather than absorbs the obscured by subretinal hemorrhage, which may break through the internal limiting
represent prolapsed orbital fat, extraocular muscles, haematoma or unrelated antral impact Since the bones of the lateral wall and the roof reusualyable to membrane with resultant subhyaloid or vitreous haemorrhage
polyps. withstand such trauma, the fracture most frequently involves the floor of Weeks to months later, on absorption of the blood, a white
the orbit along the thin bone covering the infraorbital canal. Occasionally, crescentic vetical streak of exposed underying sclera concentrnic With the optic disc
the medial orbital wall may also be fractured becomes visible.
Treatment the visual prognosis poor if the fovea is invoved
-Initial treatment generally consists of observation, with the prescription of
oral antibiotics lce packs and nasal decongestants may be helpful the patient
should be instructed not to blow his nose, because of the possibility of forcing 🔹Retinal breaks and detachment
infected sinus contents into the orbit. Posterior segment blunt trauma is responsible for about 10 percent of all cases of retinal detachment (RD)
and is the most common cause in children.
-subsequent surgical treatment is aimed at the prevention of permanent
trauma
Vertical diplopia and/or cosmetically unacceptable enophthalmos.
EYE 🔹retinal dialysis is a break occurring at the ora serrata
Blow-out medial wall fracture
Medial wall orbital fractures are usually associated with floor fracures
TRAUMA 🔹 Giant break are less frequent and are due to direct retinal disruption at the
point of sclera impact
it is uncommon to find an isolated fracture of the medial wall
Signs -RD secondary to a giant tear may occasionally be seen
include periorbital ecchymosis and frequently subcutaneous
emphysema, which typically develops on blowing the nose. Traumatic optic neuropathy
defecive ocular motility involving abduction and adduction is present if traumatic optic neuropathy follow ocular orbital ocular orbital or head trauma and presents with
the medial rectus muscle is entrapped Eye traumacan be divided into: sudden visual loss that can't be explained by other ocular pathology (RAPD in the only finding)
Diagnosis
-Globe injuries
-Lid injuries
-Orbit injuries
🔹
it occurs in up to 5 percent of facial fractures.
Classification
•direct, due to blunt or sharp optic nerve damage from agents such as displaced bony fragments,
"Proptosis, eyelid oedema and ecchymosis,haemorrhagic chemosis
ocular motility dysfunction, decrease visual acuity, elevated pupillary a projectile, or local haematoma.
defect are among the possible signs Orbital haemorrhage •indirect,(morecommon) in which force istransmitted secondarily to the nerve without apparent
orbital (retrobulbar) haemorrhage is important chiefly due to the direct disruption due to impactsupon the eye, orbit or other cranial structures
🔹
associated risk of acute orbital compartment syndrome with
Treatment compressive optic neuropathy and can
Treatment should be started immediately if progressive visual Treatment.
lead to irreversible blindness of the affected eye in severe cases Spontaneous visual improvement occurs in up to about half of patient with indirect injury however
deterioration occurs. Canthotomy alone is rarely adequate. iatrogenic orbital haemorrhage in not uncommon typically if there is initially no light perception the prognosis is poor.
resulting from a period or retrobulbar local anaesthetic block Several treatment options have been advocated but no clear benefit has been shown and all carry
•canthotomy: After clamping the incision site for 60 seconds, scissors performed to facilitate intraocular
are used to make a1-2cm horizontal full thickness incision under local significant risks..
surgery.
Anastasia at the lateral canthus
•cantolysis: Following canthotomy, the lower lid is retracted downward
and the inferior crus of the lateral canthal tendon
🔹 Abusive head trauma
abusive head trauma('shaken baby'syndrome)is aform of
physical abuse occuring typically in children under the age of 2 years.
Blunt Trauma The pattern of injury results from rotational acceleration and deceleration of
The most common causes of blunt trauma are sporting injuries the head, in contrast to the linear forces generated by a fall.
and assault, Severe blunt trauma to the globe results in anteroposterior presentation is frequenty with iritability, lethargy and vomiting which may be
compression with simutaneous expansion in the initially misdiagnosed as gastroenteritis
equatorial plane ofen associated with a transient but sever increase in IOP.
Athough the impact is primarly absorbed by the lens-iris diaphragm and the 🔹
other infecion because the History of injury is with held.
ocular features -
•Retinal haemorhages
vitreous base,damage can also occur to the posterior pole. The extent of
Ocular damage depends on the severity of trauma. The prognosis varies, but •Periocular bruising and subconiunctival haemorrhage.
is usually detemined by the extent of the retinal injury •Poor visual responses and afferent pupilary defect
by fatema okoff
🔹
cornea
corneal abrasion involves abreach of the epithelium and stains with flourescein if located
over the pupillary area,vision maybe signifilcantly impaired
Penetrating injuries are three times more common in males
than females and typically occur in a younger age group(50%
🔹 Acute corneal oedema may develop following blunt trauma, secondary to focal or diffuse
aged 15-34) the most frequent causes are assault
domestic\occupational accidents and sport.
dysfunction of the endothelium.and is sometimes seen underiying aiarge abrasion.
🔹 Tears in Descemet membrane are usually vertical and most commonly arise as the result of 🔷 Corneal
birth trauma Peaking of the pupil and shallowing ofthe anterior chamber
are key signs, though full thickness corneal penetration may
ORBIT 🔹
be present without these signs.
surgical rules:
-meticulous water-tight re-approximation of the wound without
incarceration (10/0nylon sutures)
-accessible, non self-sealing wound must be closed.
-Non viable prolapsed tissue or neglected :excised
-Viable prolapsed tissue: reposted
🔹 -prevent & treat secondary complication
🔹
Hyphaema -remove IOFB - control bleeding
🔹
Management of hyphema Hyphaema(haemorrhage in the anteriorchamber) is a common complication of blunt complications.
🔹 hospitalization if restless patient or large ocular injury. The source "of bleeding is typically the iris root or ciliary body face. -glaucoma: med ttt or surgery.
🔹 bed rest Characteristicaily, the blood settles inferiorly with a resultant fluid level except when -Ghost cell glaucoma: vitrectromy
🔹 cycloplegia topical steroid no aspirin products the hyphaema is total. -endophthalmitis: Antibiotics.
🔹 anti glaucoma (>40mmhg, 20 mmhg for 2 weeks) Uncontrolled high IOP can result in ischemic optic neuropathy and staining of the -Intraocular inflammation: steroids, cycloplegics.
anti fibrinolytic (aminocaproic acid, tranexamic acid) cornea. -Retained IOFB: removal.
-vetrous haemorrhage
surgical evacuation of hyphema: Scleral wounds
evacuation of hyphema anterior wounds are of better prognosis than the posterior
-IOP>50 mmHg for 5days wounds (occult wounds, what are the signs?)
-IOP> 35 mmHg for 7 days primary repair ofthe sclera using 7-0 absorbable sutures to
-IOP>25 mmHg for 1 day + sickle cell disease, glaucoma patient or total restore globe integrity should betheinitial priority
hyphema. Penetrating trauma
🔷
- corneal blood staining
- first sign regardless of IOP Superficial foreign body
- prolonged clot A small foreign body,such as a particle of steel,coalors and, often
- total hyphema >5 days impacts on the corneal or conjunctival surface This may be washed
- smaller hyphema >10 days along the tear film into the lacrimal drainage system or adhere to the
superior tarsal conjunctiva and abrade the cornea with every blink,When
🔹 pupil:
•The iris may momentarily be compressed against the anterior surface of the lens by
apathognomonic patten of linear corneal abrasion may be seen
A high index of suspicion should be maintained for the presence of an
IOFB posterior segment examination and if necessary plain X-ray
severe anteroposterior force, with resultant imprinting of pigment from the pupillary imaging can be used to help to exclude this
margin. Transient miosis accompanies the compression, evidenced by the pattern of If a coneal foreign body is not removed,there is a significant risk of
pigment corresponding to the size of the constricted pupil (vossius ring) secondary infection and cornea luiceration
•Damage to the iris sphincter may result in traumatic
mydriasis, which can be temporary or permanent.
The pupil tear reacts sluggishly or notat allito bothlight and accommodation. Radial
tears in the pupillary margin are common.
🔷 intaocular foreign body
An IOFB maytraumatize the eye mechanically, introduce
Iris infection or exert other toxic effects on the intraocular
🔹 Iridodialysis is a dehiscence of the iris from the ciliary body at its root.
The pupil is typically D-shaped and the dialysis is seen as a dark biconvex area
structures. it may lodge in any of the structures it
encounters,thus may be located anywhere in the anterior or
posterior segments.Notable mechanical effects
near the limbus indlude_cataract formation"secondary"to capsular injury,
-An iridodialysis may be asymptomatic if it is covered by upper lid. However, vitreous liquefaction and retinaihaemorrhages and tears. Many
monocular diplopia and glare sometimes ensue if the dehiscence is exposed in substances are inert,including glass, blastics, gold and
the palpebral aperture. silver.
Traumatic aniridia(360 iridodialysis) is rare. however iron and copper may undergo dissociation and result in
-In pseudophakic eye, the detached iris may be ejected through the cataract
surgical incision. 🔹
siderosis and chalcosis respectively.
diagnosis:
🔹
-History: revolving machines, hammering.
Cataract formation is a common sequel to blunt -Site of entry fluorescein stain
trauma. -Small, fast, sharp: no detectable entry sit
Postulated mechanisms include direct damage to the -localized cataract.
lens fibres themseives and minute ruptures in the lens -gonioscopy and fundoscopy
with an influx of aqueous humour, hydration of lens -intraocular inflammation:
fibres and consequent opacification. -CT scan is of choice
-MRI contraindicated if metallic FB is suspected
🔹 -X-ray
🔹
subluxation of the lens may occur, secondary to tearing of he
suspensory ligament. The anterior chamber may deepen over the area of surgical management
zonular dehiscence if the lens rotates posteriorly. The edge of subluxated IOFB removal by magnet or vitrectomy using forceps
lens may be seen. Lens intravital AB as prophylaxis of endophthalmitis
trembling of the iris (iridodonesis) orlens (phakodonesis) may be seen on
ocular movement. Subluxation of magnitude sufficient to render the pupil
partly aphakic may result in uniocular diplopia
🔹 dislocation due to 360 rupture of the zonular fibres is rare.
the lens may dislocate into the vitreous orinto the anterior
chamber.
