Transcript blunt injuries of the eyeball

Lecture 5
OCULAR INJURY
Lecture is delivered by
Ph. D., assistant of professor Tabalyuk Tetyana Anatolyivna
Classification of ocular injury
By conditions: agricultural, industrial, military, criminal etc.
By traumatic factor: mechanical, termal, chemical, radial,
biological etc.
By mechanism: A. blunt injuries (contusions) – lid injuries,
orbital injuries, blunt injuries of the eyeball;
B. penetrating trauma – corneal, limbal, scleral, corneoscleral;
C. burns.
BLUNT INJURIES (contusions):
lid injuries:
 haematoma,
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laceration;
orbital injuries (fractures);
blunt injuries of the eyeball:
 corneal abrasion,
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scleral rupture,
iridodyalisis,
hyphaema,
traumatic mydriasis,
lens dislocation,
haemophthalmos,
commotio retinae,
choroidal rupture,
choroidoretinal haemorrhage,
retinal detachment
A small piece of iron has lodged near
the margin of the cornea
Iridodyalisis
left - subconjunctival haemorrhage; right - blood behind the
cornea, inside the eye (hyphaema), the iris has been bleeding
Hyphaema – blood in the anterior chamber
Emergency in blunt injuries:
In corneal abrasion – antibacterial drops and ointments and
medicines, which rapid corneal regeneration, for example, Tobramycini, Chinini
hydrochloride 1% (2 drops into affected eye 4-6 times a day), Ung.”Floxali”
and Corneregel (under lower eyelid 2-3 times a day).
In hyphaema & haemophthalmos – haemostatic therapy, for
example S. Dicinoni 12,5 % 2,0 i/m 2 times a day, Tab. ”Ascorutini” per os 3
times a day, ”Vikasoli” 0,015 per os 3 times a day, Sol. Ca chloridi 3 % in
drops 4 times a day.
Foreign body of conjunctiva is removed by wet cotton, pincet or
injection needle. After removing, antiseptics are instillated and prescribed, for
example S.Sulfacili Na or S. Oftadec 4 times a day during 5-7 days.
Corneal foreign body is removed after anaesthesia (S. Alcaini)
by injection needle. Antibacterial drops and ointments and medicines, which
rapid corneal regeneration are dropped and prescribed, for example, S.
Gentamycini 0,3 %, S. Taufoni 4 % (2 drops into affected eye 4-6 times a
day), Ung.Tetracyclini and Actovegin gel (under lower eyelid 2-3 times a day).
RETINAL DETACHMENT
1. Rhegmatogenous
2. Exudative
3. Tractional
Signs of detachment – photopsia, metamorphopsia, “shadow”
before eye, peripheral visual field loss controposite the
localization of detached retina
Surgical management:
 Transscleral photocoagulation or criopexy
 Scleral buckling procedures
 Vitrectomy & intraocular silicon oil or gas tamponade
Absolute signs of penetrating injury:
corneal or scleral wound;
intraocular foreign body;
extrusion of intraocular tissues (iris, choroid,
vitreous, lens, etc) through the wound
Relative signs of penetrating injury:
hypotonia;
pupil deformation;
changing of anterior chamber depth (flat or deep).
Eye injury by impact of small plastic body
Open eye injury, with iris prolapsed through
the cornea laceration. This type of injury
needs immediate eye care attention
Methods of localization of intraocular foreign body:
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X-ray examination (metal foreign body - with special protesis of
Komberg-Baltin; nonmetal (glass) –X-ray examination by Fogt)
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Ultrasound examination;
Complications of penetrating injury:
traumatic cataract;
traumatic iridocyclitis;
endophthalmitis;
panophthalmitis;
sympathetic ophthalmia (chronic fibro-plastic autoimmune iridocyclitis of
the unaffected eye)
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Emergency in eye penetrating injury
cleaning the wound,
using antiseptics locally (i.e. S. Furacilini 1: 5000 or S. Laevomycetini 0,25 %),
analgetics (S. Analgini 50 % 2,0 i/m),
antibiotics systemically (i.e.Tab. Ofloxacini 0,2 per os or S. Gentamycini
sulfatis 4 % 1,0 i/m),
binocular dressing,
transportation the patient in horizontal position into the special department
CLASSIFICATION of BURNS
I degree – hyperemia of conjunctiva;
superficial opacity of cornea or corneal abrasion which
disappears without any changes
II degree – superficial necrosis of conjunctiva
gray & cloudy cornea (defect of epithelium & superficial
layers of stroma)
III degree – necrosis of hole conjunctiva
defect of all corneal layers – “mat” cornea
IV degree – necrosis not only of conjunctiva, but also sclera
“porcelain” cornea
Emergency in eye burns
removing of foreign pieces especially in case of lime’s burn, watering of
the eye by water, Sol. Na isotonici or S. Furacilini during 15-30 minutes,
using of antiseptics or antibiotics in drops (S. Dimexidi 10 %, ”Ciloxan” or
”Tobrex”)