In the last classes

 1.A common cause of unilateral blindness in

children and young adults
 2.1 Eyelid and Lacrimal Trauma
 2.2Blunt Trauma
 2.2.3Traumatic Iritis
 2.2.5Hyphema
 2.2.6Traumatic Cataract
 In the last classes

2.3 ocular perforating trauma

 penetrating wound
 In the last classes
Corneal metallic foreig
2.4ocular /orbital foreign body body with rust ring
 Corneal / Conjunctival Foreign Bodies
 IOFB
 orbital foreign body
 In the last classes

2.5Chemical burns

 Alkali more severe than Acid

 Alkali can penetrates through ocular tissues rapidly

and continue to damage

 Acid form a barrier of precipitated necrotic tissue

Limit penetration and damage

 In the last classes
How to treat chemical burns?

In the site of injury

 Tap-water lavage
 Irrigate away obvious foreign body
In the emergency room
 Brief history and examination
 Irrigation ocular surfaces—conjunctival fornices
Copious irrigation using saline for at least 30 minutes
following treatment
 Cycloplegic
 Topical antibiotic
 Topical steroid
 Lysis of conjunctival adhesions
 amniotic membrane transplant if healing is delayed beyond 2 weeks
 Ascorbate for alkali burns to speed healing time and allow better visual outcome.
 If any melting of the cornea occurs, Oral tetracyclines may reduce collagenolysis.
orbit
Chuanbao-Li
Orbital Disease

1.This section provides a framework to

evaluate a variety of orbital diseases

2.Symptoms:Eyelid swelling, bulging

eye(s), and double vision are common.
Pain and decreased vision can occur.

3.Critical Signs:Proptosis and

restriction of ocular motility.
 Etiology

Orbital disease can be grouped into5types :

 Inflammatory: thyroid-related orbitopathy
 Infectious: orbital cellulitis.
 Neoplastic: optic nerve glioma, lymphoma.
 Trauma: orbital blow-out fracture,
 Malformation: congenital, vascular, others.
 Work-Up

 1.History: Rapid or slow onset? Pain? Fever,

systemic symptoms? History of cancer, diabetes,
Trauma?
 2. Vital signs: particularly temperature
 3.External examination:
—Look for nonaxial displacement of the globe
—Test for resistance to retropulsion by gently
pushing each globe into the orbit.
—Feel along the orbital rim for a mass. Check the
conjunctival cul-de-sacs carefully and evert the
upper eyelid.
 Work-Up

 3.External examination:
 —Check extraocular movements. Measure any
ocular misalignment with prisms .
 —To examine for proptosis, Measure with a
Hertel exophthalmometer. Upper limits of normal
are approximately 12 - 14 mm . A difference
between the two eyes of more than 2 mm is
considered abnormal.
 Work-Up

 4.Ocular examination: Specifically check the pupils,

visual fields, color vision (by color plates), IOP ,
optic nerves, and peripheral retina.
 5.Imaging studies: Orbital CT or MRI.
 6. Laboratory tests when appropriate:
 Thyroid-Related Orbitopathy

eyelid retraction and proptosis of the right eye.

 Thyroid-Related Orbitopathy

Synonyms:
Thyroid Eye Disease or Graves Disease

Ocular Symptoms
 Early: nonspecific complaints including foreign body
sensation, redness, tearing, photophobia
 Late: eyelid and orbital symptoms including
prominent eyes, persistent eyelid swelling, double
vision, “pressure” behind the eyes, and decreased
vision in one or both eyes.
 Thyroid-Related Orbitopathy

Signs
 Critical. 1.Retraction of the eyelids (highly specific)
2.lagophthalmus. Unilateral or bilateral axial
proptosis with resistance to retropulsion.
 3.When extraocular muscles are involved, elevation
and abduction are commonly restricted .
 4.Although often bilateral, unilateral or asymmetric
thyroid-related orbitopathy (TRO) is also frequently
seen. Thickening of the extraocular muscles
(inferior, medial, superior, and lateral) without
involvement of the associated tendons may be
noted on orbital imaging.
 Thyroid-Related Orbitopathy

Signs
 Other. Reduced frequency of blinking (stare),
chemosis, significantly elevated intraocular pressure
(especially in upgaze), superior limbic
keratoconjunctivitis,etc
 Thyroid-Related Orbitopathy

 Treatment
 1.Smoking cessation: All patients with TRO who
smoke must be explicitly told that continued
tobacco use is especially dangerous. This
conversation should be clearly documented in the
medical record. Smokers have a higher incidence of
Graves disease and more severe orbitopathy.
 2.Refer the patient to a medical internist or
endocrinologist for management of systemic thyroid
disease, if present.
 Thyroid-Related Orbitopathy

 Treatment
 3.Treat exposure keratopathy with artificial tears
and lubricating or by taping eyelids closed at night.
 4. Treat eyelid edema with cold compresses in the
morning and head elevation at night .
 5. Indications for orbital decompression surgery
include: optic nerve compression; worsening or
severe exposure keratopathy despite adequate
treatment (some patients may develop infectious
corneal ulceration or melting from lagophthalmos);
uncontrollable high IOP; or cosmesis.
 Thyroid-Related Orbitopathy

Follow-Up
 1.Optic nerve compression requires immediate
attention.
 2.Patients with advanced exposure keratopathy and
severe proptosis also require prompt attention.
 3.Patients with minimal to no exposure problems
and mild to moderate proptosis are reevaluated
every 3 to 6 months. Because of the increased risk
of developing optic neuropathy, patients with
restrictive strabismus should be followed more
frequently.
 Thyroid-Related Orbitopathy

Follow-Up
 4.All patients with TRO are instructed to check for
color (red) desaturation once every 1 to 2 weeks,
and to return immediately with any new visual
problems.
Orbital Cellulitis
 Orbital Cellulitis

Etiology
 1.Direct extension from a paranasal sinus infection or
dental infection.
 2.Complication of orbital trauma .
 3.Complication of orbital surgery or paranasal sinus
surgery (more common).
 4.Vascular extension (e.g., seeding from a systemic
bacteremia )
 When a foreign body is retained, the cellulitis may
develop months after injury.
 Orbital Cellulitis

Symptoms
 Red eye, pain, blurred vision, double vision, eyelid
swelling, nasal congestion, sinus headache, tooth
pain.
 Orbital Cellulitis

Signs
 Critical. Eyelid edema, tenderness. Conjunctival
chemosis and injection, proptosis, and restricted
ocular motility with pain on attempted eye
movement are usually present. Signs of optic
neuropathy
 Other. Decreased vision, optic disc edema, fever.
possible orbital abscess.
 Orbital Cellulitis

Treatment
 1.Admit the patient to the hospital and consult
Infectious Disease.
 2.Broad-spectrum intravenous (i.v.) antibiotics to
cover Gram-positive, Gram-negative, and anaerobic
organisms are required for at least 72 hours,
followed by p.o. medication for 1 week.
 Low Vision

 Low-vision patients typically have impaired visual

performance, visual acuity not correctable with
conventional glasses or contact lenses. They may
have cloudy vision, constricted fields, or large
scotomas.
 There may be additional functional complaints:
glare sensitivity, abnormal color perception, or
diminished contrast.
 Some patients have diplopia. A frequent complaint
is confusion from overlapping but dissimilar images
from each eye.
 Low Vision

 In the United States, over 6 million persons are

visually impaired but not classified as legally blind.
Over 75% of patients seeking treatment are age 65
or older.
 Age-related macular degeneration accounts for an
increasing number of cases. Other common causes
of low vision are complicated cataract, corneal
dystrophy, glaucoma, diabetic retinopathy, optic
atrophy, degenerative myopia, and retinitis
pigmentosa.
 Approximately 9% of the low-vision population is
pediatric, resulting from congenital eye disorders or
trauma.
 Blindness

Blindness: Introduction
 blindness is a worldwide health problem,
Definition of Blindness
 The World Health Organization (WHO) defines visual
impairment as shown in Table :
 Categories of Visual Impairment
(Adapted from International Classification of Diseases, WHO,
1977).
Category of Visual Impairment Visual Acuity (Best Corrected)
Better worse
Low Vision 1 <0.3 ≥ 0.12

2 <0.1 ≥0.05

Blindness 3 <0.05 ≥0.02

4 <0.02 light
perception
5 NLP