Ocular Injures - Mechanical Penetrating Trauma

Who is most commonly affected by penetrating ocular injuries?

Young males; injuries are around 3 times more common in males.

Common causes of penetrating ocular trauma?

Assault

domestic/ occupation accidents

Sport

What determines the extent of damage caused by a flying foreign body?

Its kinetic energy.

Major risk associated with penetrating ocular injuries?

Infection.

What is the management priority for penetrating trauma?

EMERGENCY - PX IMMEDIATELY SENT TO A and E

Why are penetrating injuries considered emergencies?

Due to risk of damage and infection.

How can infection occur in penetrating trauma?

The wound provides an entry route for pyogenic bacteria.

Examples of objects causing penetrating trauma?

Needles, sticks, pens, knives, arrows, pencils, glass, hammers/chisels, thorns, darts.

Why do eyelid lacerations need emergency referral?

• Lid margins torn - must be sewn together accurately

• Lacrimal ducts have been damaged - cut ends must be reapplied

What determines the repair technique for corneal penetrating injuries?

The wound and associated complications.

Which scleral lacerations have a better prognosis?

Anterior scleral lacerations.

Why do posterior scleral lacerations have worse prognosis?

Greater risk of posterior segment damage.

What is an intraocular foreign body (IOFB)?

A foreign object retained within the eye after penetrating injury.

How can an IOFB damage the eye?

Mechanical trauma, infection, or toxic effects.

Where can an IOFB lodge?

Anywhere in the anterior or posterior segment.

Mechanical complications caused by IOFBs?

Cataract formation, vitreous liquefaction, retinal haemorrhage, and retinal tears.

Which foreign bodies carry higher infection risk?

Stones and organic foreign bodies

Which IOFB materials are relatively inert?

Glass, plastic, gold, and silver.

What is siderosis?

Toxic iron deposition (rusting) in the eye caused by iron foreign bodies.

What is chalcosis?

Copper deposition causing green-blue ocular discoloration.

Retinal complications of IOFBs?

Retinal tears and retinal detachment.

Define bacterial endophthalmitis.

Severe intraocular infection following penetrating injury.

Signs of bacterial endophthalmitis?

Lid oedema, conjunctival chemosis, corneal haze, cells/flare, hypopyon, absent red reflex, vitritis.

pupil light reflex may be sluggish or absent

How may IOP present in endophthalmitis?

It may be normal, low, or raised.

Common pathogens in bacterial endophthalmitis?

Staphylococcus spp. and Bacillus spp.

Management of bacterial endophthalmitis?

EMERGENCY REFERRAL

First-line management for penetrating ocular injuries?

First aid followed by immediate referral with no intervention

emphasise to px urgency of condition and instruct them to attend A&E immediately - explain that you’ll leave message so that they are expected

• Advise px not to eat or drink anything

• if full thickness suspected - Advise px not to cough or strain

Why should patients with penetrating injury be Nil by mouth?

They may require emergency surgery under general anaesthesia.