Transcript Open Globe Injuries of the Eye

Learning Outcomes
By the end of this lecture the students
would be able to
 Diagnose OGI of the eye
 Describe the complications of OGI
 Describe the principles of management
of OGI
 Recommend measure for the primary,
secondary and tertiary prevention of
OGI
A 15 year old boy was hit in the eye with
a cricket ball which of the following
would the most likely complication
a) Choroidal Tear
b) Hyphaemia
c) Macular Hole
d) Optic Nerve Avulsion
e) Scleral Rupture
A 30 year old lady presents with the complaint
of splashing of some chemical into her right eye
while cleaning the toilet, what would be the most
appropriate first line of management
 Ascertain the degree of limbal ischemia
 Perform a vigilant examination
 Refer to an ophthalmologist
 Take a detailed history
 Wash the eye with copious amount of
water
OGI of the eye-Diagnosis
History
 Clinical examination
 Investigations

Management
1. Proceed with caution
2. Assess the total patient first: Make sure there is no life
threatening injury and the patient is hemodynamically
stable before proceeding with your exam.
3. Make the patient comfortable
4. Assess visual acuity and pupils
5. Assess the adenexal structures
6. Visualize the globe
Management
7. Evaluate the fellow eye
8. Use additional testing and imaging
modalities
9. Refer for the repair
10. Talk with patient and family.
OGI with Intraocular Foreign Bodies (IOFB)

May damage the eye
○ Mechanically
○ Introducing infection
○ Causing severe inflammation
○ Toxic effects

Location of foreign bodies
○ Cornea
○ Anterior Chamber / Iris
○ Lens
○ Posterior Segment
○ Orbital
Types of foreign bodies

Inert
• Glass
• Stone
• Gold

Organic
• Plant
• Animal

Metallic
• Iron - Siderosis
• Copper- Chalcosis
OGI with I.O.F.B- Summary
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Suspected in any ocular/orbital trauma.
Detailed Hx is important.
X-Rays(frontal/lateral)…..for presence
C.T…..for location.
MRI…..contraindicated(for metallic)
Electrophysiological test to assess integrity of
optic nerve and retina
Infection (endophthalmitis/ panophthalmitis)
Structural and functional damage and are the
biggest threats
Siderosis bulbi
Sympathetic
Ophthalmitis
Definition
“Sympathetic Ophthalmitis is a very rare ,
bilateral,diffuse granulomatous panuveitis
which occurs after penetrating ocular trauma,
that is usually associated with uveal prolapse
or rarely following intraocular surgery.”
Sympathetic Ophthalmitis
Trauma to Ciliary body and retina
 Retinal S-antigen
 Exciting eye (the injured eye)
 Sympathizing eye ( the normal/uninjured
eye)
 Chronic granulomatpus inflammation
 Sympathizing Eye also develops
uveitis

Clinical presentation
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Mostly (65-80% of the cases ) sympathetic uveitis
develop between 2 weeks & 3 months after initial
injury.
90% of all cases occur within the first year.
Anterior Segment:
 The Exciting eye -- evidence of initial trauma, excessively
red & irritable, signs of granulomatous uveitis
 Sympathizing eye -- irritable, photophobia
 then bilateral granulomatous anterior uveitis with iris nodules
& mutton fat KPs

Posterior Segment:
 Optic Disc swelling & multifocal choroiditis
 mostly the process becomes chronic & may be complicated
by cataract, glaucoma & phthisis bulbi
Treatment
Topical & Systemic Steroids
 Immunosuppressive therapy in steroidresistant cases(Cyclosporin)
 Enucleation of the injured eye, if
performed within 7-10 days of the injury
prevents sympathetic ophthalmitis.
Enucleation of the exciting eye is of no
benefit once the fellow eye becomes
inflammed

Thermal Burns
Usually caused by


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Flames
Hot splashes
Direct contact of hot metals
Usually limited to the lids and the cornea
Management
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Relive pain
Prevent secondary infection of cornea from exposure
Minimize Eye lid scarring
Limited debridement
Macular burn by solar eclipse
Ultra-violet Radiation Injury
Caused by
Welding arcs
Snow blindness
Involves cornea, very painful
Heals within 24 hours
Management
Relive pain, cycloplegic agent, antibiotic eye
drops / ointment
Patch the eye
Test
Refractive errors
2. Strabismus
3. Amblyopia
4. Uveitis
5. Ocular injuries
1.
15 MCQs+ 5 Marks for the HW assignment
Total 20 marks