Transcript Penetrating-Eye-Injuries

PENETRA
TING EYE
INJURIES
LT COL
QAMAR UL ISLAM
CLASSIFIED EYE SPEC / ASST
PROF
AFIO , RAWALPINDI
EPIDEMEOLOGY
• Ocular trauma is the leading cause of monocular blindness in
people < 40 yrs of age
• Accounts for approx 50% of all ocular emergencies
• More common in males (78 - 84%)
• Usually occur at workplace
(outdoor location)
IMPACT OF OCULAR INJURY
• Physical disability
• Social dependency
• Financial implications
TYPES OF OCULAR INJURIES
RADIATION
MECHANICAL
OCULAR
TRAUMA
THERMAL
CHEMICAL
Mechanical Ocular Trauma
Closed Globe
Contusion
Lamellar
Laceration
Open Globe
Rupture
Penetrating
Laceration
Perforating
TERMINOLOGIES
CLOSED GLOBE INJURY
• Blunt trauma
• Corneoscleral wall intact
• Intraocular damage
OPEN GLOBE INJURY
• Full thickness wound
of the corneoscleral wall
CLOSED GLOBE LAMELLAR
INJURY
CONTUSION
• Closed injury resulting from
blunt trauma
• Damage at site of impact or at
a distant site
LACERATION
• Partial thickness wound
caused by sharp object
OPEN GLOBE INJURY
RUPTURE
• Full thickness wound caused
by blunt trauma
• Globe gives way at the
LACERATION
• Full thickness wound caused
by sharp object
• At the site of impact
weakest point
(inside to outside)
(outside to inside)
OPEN GLOBE INJURY
PENETRATION
• Single full thickness wound
PERFORATION
• Two full thickness wounds
without an exit wound
• Retained intraocular foreign
body
• Entry and exit
PENETRATING/PERFORATING OCULAR TRAUMA
• CAUSES : Assault, domestic accident (sharp obj like pen, pencil,
scissors, knives, broken spectacles) disposable syringes, sport
injuries, windshields of cars in RTA, mine/missile blast injuries,
fire arm injuries, chopping or cutting wood, hammering metals or
nails
PENETRATING/PERFORATING OCULAR TRAUMA
• MECH OF INJURY :
 Size of object
 Speed at the time of impact
 Composition of object
o SHARP OBJECT
well defined laceration of globe
o FLYING F.B
damage related to their kinetic energy
o RETAINED IOFB
• MECHANICAL EFFECTS
• INTRODUCTION OF INFECTION
• TOXIC/CHEMICAL EFECTS
Main Symptoms/Signs
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Redness of eye,
Haemorrages
Congestion
Lacrimation
Photophobia
Raised Eyelids
Itchy/Watery Eyes
Blurring or Loss of Vision
Change in Pupil Shape
Blood or Fluid Leakage from the Eye
Foreign Object Penetrating Eye
Effects Of Penetrating Ocular Injuries
• Mechanical effects:
Laceration of the conjunctiva, corneal
lacerations,Vitreous haemorrage, rupture of globe, retinal tears and
detachments, scarring which leads to cataract and glaucoma. And Intra
ocular foriegn bodies.
• Introduction of infection: the entrance of the wound may serve as
a route of entry for pyogenic bacteria,which may lead to the fromation
of abscess of cornea, purulent iridocyclitis or Endophthalmitis
• Sympathetic Ophthalmitis:
injury.
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It is a complication of penetrating
Visual impairment and Enucleation
Effects Of Penetrating Ocular Injuries
Effects Of Penetrating Ocular Injuries
MANAGEMENT GUIDELINES
* In general always suspect more extensive
injury than may be readily apparent and
search carefully for any defects in the
integrity of the globe or intraocular foreign
bodies
MANAGEMENT GUIDELINES
Medical Reception Centre
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Make the patient comfortable
 Take vital signs
 Assess the degree of damage
 Take Visual Acuity
 Torch examination
 Distant Direct Ophthalmoscopy
 Documentation
MANAGEMENT GUIDELINES
GENERAL PRINCIPLES
• Determine the nature and extent of any life-threatening problems
• History – circumstances, timing, likely object
• Ocular examination (minimal handling)
»
Eyes
»
Orbits
• Application of eye pad
• Psychological (avoid negative reassurance !!!!!!!)
• Referral to eye specialist
MANAGEMENT GUIDELINES
INVESTIGATIONS
X- Ray Orbit
Ultrasonography
CT SCAN
MANAGEMENT GUIDELINES
PRINCIPLES OF SURGICAL REPAIR
• PRIMARY REPAIR
» Undertaken immediately
» Preserve visual acuity
» Remove the dead and devitalized tissue
» Preserve as much normal tissue as possible
» Close any open wounds
» Prevent / treat any nidus of infection
• SECONDARY REPAIR
» 10 – 14 days after primary repair
» Clear opacities of the media
» Stabilize abnormal vitreoretinal interactions
MANAGEMENT GUIDELINES
• Prophylaxis of Endophthalmitis
Antibiotics
• Enucleation
(when nothing to salvage)
MANAGEMENT GUIDELINES
• REMOVAL OF IOFB
TECHNIQUE OF REMOVAL OF IOFB depends on :
o Chemical composition
o Location
o Size of IOFB
o Clarity of media
o Phakic status
o Toxicity of IOFB
MAGNET removal
FORCEPS removal
MANAGEMENT GUIDELINES
Don’ts and Do’s
• DO NOT flush the eye with any liquids other than saline or warm water or
even better just do
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not touch the eye
DO NOT remove the object out of the eye
DO NOT put any pressure on the eye
Do NOT rub your eye.
Reassure the person and advise against rubbing or moving their eye
as this can cause further damage
• If the injury is severe, place a moist pad and loosely bandage the
eye.
• Transport the patient to the nearest Hospital as fast as possible
• In the case of small penetrating objects, use a cup to cover the object
and keep the person calm and lying down until help arrives.
TAKE HOME MESSAGE
 Anticipation of complications requiring referral to
ophthalmic surgeon
 The nature and possible consequences of the
patient’s condition should be communicated to the
patient and his family as accurately and honestly
as possible
 Never trivialize a condition since untoward
complications can make for a very dissatisfied
patient and a vulnerable physician
IMPACT OF OCULAR INJURY