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Objectives
a) Diagnose b) Primary management of common ocular injuries
WHY ?
a) Associated with other injury. May present to you first eg., RTA. b) Primary t/t : saves the eye and vision eg., Corneal abrasion/ Chemical burns c) t/t provided by you may be the only t/t available.
Epidemiology
Ocular trauma is an important, preventable public health problem worldwide. As many as half a million people in the world are blind as a result of ocular injuries. Such injuries also are common causes of monocular blindness; one third to 40% of monocular blindness may be related to ocular trauma. In the United States, approximately 2.4 million ocular injuries are estimated to occur each year.
2. Lid Laceration :
y Clean with Betadine y Cold compression y Local antibiotics y Broad spectrum systemic antibiotics y Patch the eye y Analgesics y REFER THE PATIENT
6. Corneal abrasion :
y Local antibiotics y Patch the eye for 24 hours y Continue antibiotics TDS x 3 days y If pain persists/ infiltration develops, pt. may be developing Corneal Ulcer y REFER IMMEDIATELY
Epithelial defect stained with fluorescein
7. Corneal Ulcer :
y Sight threatening. Refer immediately y If Eye Centers far away : start primary t/t and then refer y primary t/t a. Ciprofloxacin eye drops + Gentamycin eye drops : hourly b. Neosporin eye ointment : bed time c. Atropine 1% drops/ ointment : TDS
2. Counter coupe force generated after the initial movement is blocked by the sclera
BLUNT INJURIES
Injury to ciliary body/iris
Traumatic mydriasis Vossius ring Iridodialysis Traumatic hyphema Angle recession
Posterior segment Commotio retinae Choroidal tear Giant retinal tear Postraumati
Iridodialysis
Vossius ring
Angle recession
8. Traumatic Hyphema
y Absolute bed rest - 48 hrs. y Bilateral eye patching y Admit the patient, supervise for 1 week. Watch for secondary hemorrhage y Guarded prognosis y Refer at appropriate time
Hyphema
y If Blood > 1/2 in anterior chamber, start Acetazolamide (Diamox) x QID x 3 days Syp Potassium Chloride x 1tsf xTDS x 3 days PREVENTS BLOOD STAINING OF CORNEA
9. Lens injuries
1. Traumatic rosette 2. Intumescent cataract 3. Dislocated lens Secondary glaucoma