Term
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Definition
most common cause of unilateral blindness (90% preventable!)
routine and serious types of injuries |
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Term
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Definition
corneal abrasion
conjunctival and corneal foreign body |
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Term
| potentially serious injuries |
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Definition
chemical burn
blunt injury to the eye
lacerating injury to the eye
intraocular foreign body
orbital wall fractures |
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Term
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Definition
*HISTORY* is critical
-mechanism: foreign body, chemical injury
-timing
-uni vs. bilateral
past ocular history
-baseline vision
-previous surgeries (increases risk for having injury deeper in eye, even with minor trauma) |
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Term
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Definition
pain is NOT always proportional to the severity of the injury
sensory innervation:
CN V (trigeminal)
-anterior globe, extensive
-posterior globe, none (retina, choroid, sclera)
-referred pain from damaged extraocular structures |
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Term
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Definition
basic eye exam:
visual acuity ASAP
pen light
pupils, motility
minimize palpation or forcing lids open when suspicious of open globe injury |
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Term
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Definition
IRRIGATION IMMEDIATELY
alkalis penetrate and cause more permanent damage
remove particulate matter from conjunctival sac and cornea
topical antibiotic
refer immediately |
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Term
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Definition
| superficial and conjunctival foreign bodies are the most common cause of ocular injuries but RARELY cause severe or permanent ocular damage |
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Term
foreign body removal
conjunctival |
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Definition
may have to evert lids
use topical anesthetic and irrigate to flush out FB, or use cotton tipped applicator |
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Term
| post-foreign body removal |
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Definition
stain the corneal surface to identify defects
trat with topical antibiotic
refer within 24 hours if corneal defect, and with symptoms when FB can't be identified |
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Term
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Definition
usually more symptomatic
MUST use topical anesthetic, then irrigate
refer if rust ring - need to get it ALL out
if injury is deeper than corneal epithelium, scarring will occur, which may result in permanent loss of vision |
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Term
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Definition
very common
may not be seen without slit-lamp and fluorescein staining
often from contact lens abuse
-topical anesthetic dramatically relieves pain
**do NOT give/prescribe topical anesthetic drops to patient** |
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Term
| corneal abrasion management and FU |
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Definition
pressure patch to prevent eye from opening
refer if persistent defect, pain, corneal edema after 2 days
if contact lens wearer - refer and no patch, antibiotic drops; high risk of infection |
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Term
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Definition
extent of injury is difficult to assess from initial external eval
get history, apply eye SHEILD
refer immediately |
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Term
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Definition
blunt injury involving fracture of orbital bones
may get extra ocular muscle entrapment limited globe movement |
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Term
| subconjunctival hemorrhage |
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Definition
selt limiting
seolves in about 2 weeks
need a complete eye exam to rule out any other associated ocular injury |
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Term
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Definition
a peaking pupil in the setting of trauma = BAD
indicated rupture of the iris sphincter muscle
possible severe ocular injury
shield eye and refer right away |
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Term
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Definition
layering of RBC
bleeding into the anterior chamber
shield and refer ASAP
indicated severe ocular trauma |
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Term
| lens dislocation or retinal injury |
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Definition
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Term
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Definition
openings in the top and bottom of the lids drain to lacrimal sac and duct - can get permanent tearing if not repaired correctly
can get laceration parallel to lid margin (not at bad) or within the lid margin-->must be repaired by an ophthamologist |
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Term
| lid and globe lacerations |
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Definition
lid lacerations can be associated with globe lacerations - manage accordingly
very serious
shield and refer for eval ASAP |
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Term
| triage of globe lacerations |
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Definition
be suspicious from history
usually associated with a "foreign" object - knife, tool, nail, staple, windshield glass, small objects at high speed - or severe blunt injury |
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Term
| globe laceration management |
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Definition
removal must be done in a controlled setting
check vision in each eye
look for hemorrhage, hyphema, abnormal pupil reactions/irregular pupil, prolapse of iris/ciliary body
Triage - Shield - Refer ASAP |
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Term
| potential outcomes of globe lacerations |
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Definition
sever injury can cause loss of useful vision, marked disruption of intraocular structures, enucleation of non-salvageable tissue
later: corneal scars, glaucoma, cataract |
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Term
| prevention of ocular trauma |
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Definition
protective eye wear, including goggles, spectacles
-sports
-occupations
national standards: polycarbonate 3mm central thickness, industrial frame, 100% UV blockage |
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Term
ocular trauma
managament cliff notes |
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Definition
chemical burns: irrigate immediately
foreign bodies: refer to ophthalmologist with corneal abrasion, central location
corneal abrasion: do not patch in contact lens patients
blunt trauma/laceration: refer after triage |
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