OCULAR TRAUMA

OCULAR TRAUMA

OCULAR TRAUMA




OCULAR TRAUMA

The structure of your face helps protect your eyes from injury. Still, injuries can damage your eye, sometimes severely enough that you could lose your vision. Most eye injuries are preventable. If you play sports or work in certain jobs, you may need protection.The most common type of injury happens when something irritates the outer surface of your eye. Certain jobs such as industrial jobs or hobbies such as carpentry make this type of injury more likely. It’s also more likely if you wear contact lenses. Chemicals or heat can burn your eyes. With chemicals, the pain may cause you to close your eyes. This traps the irritant next to the eye and may cause more damage. You should wash out your eye right away while you wait for medical help.Physical or chemical injuries of the eye can be a serious threat to vision if not treated appropriately and in a timely fashion. The most obvious presentation of ocular (eye) injuries is redness and pain of the affected eyes. This is not, however, universally true, as tiny metallic projectiles may cause neither symptom. Tiny metallic projectiles should be suspected when a patient reports metal on metal contact, such as with hammering a metal surface. Intraocular foreign bodies do not cause pain because of the lack of nerve endings in the vitreous humor and retina that can transmit pain sensations. As such, general or emergency room doctors should refer cases involving the posterior segment of the eye or intraocular foreign bodies to an ophthalmologist. Ideally, ointment would not be used when referring to an ophthalmologist, since it diminishes the ability to carry out a thorough eye examination.

CHEMICAL BURN

Immediately Irrigate the eye with normal saline (or equivalent isotonic solution) now. If nonsterile water is the only liquid available, It should be used.

You will need a number of saline bags and towels. Sit the patient by a sink. Instilanaesthetic drops and gently tilt the patient’s head back so that they are holding it over the rim of the sink, explaining what you are going to do (this is easy to forget in the rush and irrigation can be unpleasant in the first few moments, until a steady stream is achieved). Remove contact lenses if present..

Use a 500 mL bag of saline and empty it into the conjunctival sac, using a purpose-built irrigator if you have one – orcut the end of the tubing if necessary to deliver the fluid more quickly.

Ensure that both upper and lower fornices are irrigated. As a rough guide, check the pH between bag changeovers. You will need several bags; the volume required to reach a neutral pH varies but may be up to 10 L in severe cases.

WORRYING FINDINGS AND REASONS TO REFER

SERIOUS SYMPTOMS

* Reduced visual acuity, particularly if progressive.

* Pain unrelieved by local anaesthetic drops.

* Diplopia.

* Flashes and (new) floaters – can indicate retinal injury.

SERIOUS SIGNS:

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* Deep lid laceration – there may be damage underneath it

* Subconjunctivalhaemorrhage or conjunctival laceration:

* In context of eye trauma, can indicate open globe injury, especially if there is severe or diffuse haemorrhage. If it tracks posteriorly, it may indicate fracture.

* Any pupil, iris or fundal abnormality:

* Hyphaema, irregular pupil, or decreased intraocular pressure suggests that an object has gone at least into the anterior chamber. Hyphaema indicates significant eye injury.

* A teardrop-shaped pupil indicates open globe injury.

* Vitreous haemorrhage suggests injury to the posterior segment of eye.

* A positive Seidel’s test (below) – indicates penetration of the cornea, ie open globe injury.

* Abnormalities of eye movements, proptosis or enophthalmos – indicate damage in the orbital area or to extraocular muscles

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THE FOLLOWING INJURIES REQUIRE URGENT REFERRAL TO AN OPHTHALMOLOGIST:

* Chemical burn, open globe injury or retrobulbarhaemorrhage (RH) (immediate referral).

* Difficulty in making a full assessment, eg unclear history, lid swelling, a young child, or reduced conscious level.

* Any of the ‘serious symptoms and signs’, above.

* Intraocular FB – known or suspected (if a high-velocity injury, this must be excluded).

* Corneal foreign body, which cannot be removed.

* Corneal opacities, rust rings or large corneal abrasions.

You are in a good hands....