Random Trauma Tips

7-14-10 jshum

Eye Anatomy
Sclera Iris

Choroid

Pupil

Cornea Retina Lens

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Orbital Architecture

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

Common Minor Eye Injuries

Corneal abrasion Corneal foreign body Hyphema Traumatic iritis Bleeding Lacerations

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 tearduct 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 to orbital 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

Subconjunctival Hemorrhages
Definition Symptoms Signs Complete exam Treatment

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 RBCs I <1/3 II 1/3 1/2 III > 1/2 IV eight ball

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

Iritis- Presentation
Definition Symptoms Photophobia Eye pain Signs Limbus injection Miosis Mydriasis VA

Iritis Management
Complete Examination. Cycloplegic NSAIDS Sunglasses No antibiotics Topical steroids? Follow-Up

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

Fluorescein Test
Topical eye dye COBALT light

Corneal Abrasion

Corneal Abrasions

Abrasion Treatment
Erythromycin ointment +/- patch 1-2 day follow-up with eye doc

Retrobulbar Hemorrhage - Presentation

Definition Symptoms Critical signs Proptosis Visual acuity Marcus-Gunn pupil Red desaturation

Retrobulbar HemorrhageManagement
TIME IS RETINA Progressive Lateral canthotomy CT scan of orbit Disposition