Ocular injury

A.Closed globe injury——→contusion, lamellar laceration, superficial foreign body

B.Open globe injury———> laceration——→ pernetrating, perforating

intraocular foreign body

rupture

Mechanical injury

Mode of injury

CLosed globe injury clinical features

SIngle full thickness wound without an exit wound caused by a sharp object

Penetrating injury

Two full thickness wounds of the eyewall with both an entry and an exit wound caused by a sharp object.

Perforating eye injury

Mechanical effects of the trauma

Introduction of infection

Post traumatic iridocyclitis

sympathetic ophthalmiitis

Effects of penetrating/perforating injury

Cornea-superficial stroma and sometimes deep strona

Conjunctiva-sulcus subtarsalis,fornix, bulbar conjunctiva

Where is extraocular foreign body commonly impacted?

In the conjunctiva-

Removal by a cotton swab or clean handkerchief if present in the lower fornix, sulcus subtrasalis and the canthi if visble

In bulbar conj-hypodermic needle after topical anaesthesia

In the cornea- topical anaethesis, lid seperation using universal speculum -wet cotton swab stick if fails foreign body spud or hypodermic needle, if magnetic strong magnet used, bandage and pad containing antibiotic oinment for 24-48 hrs, antibiotic eye drops are instilled 3-4 times a day for about a wee.

Treatment of extraocular FB

causing inflammatory reaction-

iron steel, copper

causing infection

woood, stone, organic substances

inert fb-gold,glass,silver,plstic, paltinum, lead pellets

Types of intraocular fB

history

ocular examination-visual acquity, wound entry, slit lamp examination, goniosocopy, iop emasurment, fundus exmaination.

plain xray orbit-anteroposterior and lateral views

localizaation of iofb-

radiography": limbalring method- a metallic ring aboout the size of cornea is stitched at the limbus and xray is taken one in anteropost view and threee on lat view where pt is looking up down and straight. iofb localised with relation to the limbal metallic ring.

usg localisation

ct scan -best method

Investigations of IOFB

fb in anterior chamber- direct cornela incision towards the fb 3mm internal to the limbus and over the quadrant directly above the fb.

in the iris tisssu- secto iridectomy containing the fb

in the viterous and retina - viterous- pars planasclerotomy(5mm from the limbus)

intraretinal- sclerotomy adjacent to fb

forceps removal after three pore pars plana vitrectomy for non magnetic fb

Treatment of iofb

Alkalo injury— ammonia

Most common chemical injury

MOA of alkali injury

a. stage of acute ischaemia-

conjunctiva-edematous, red, congested, copious purulent dicharge. cornea-sloughing, oedema, opacification

iris-vary inflamed, iris and pupil body =replaced by granulation tissue.

b. stage of reaparation- conjunctiva and corneal epithelium regenerate, corneal vascualrization, inflammation of the iris subsides.

c. stage of complications- development of symblepharon, corneal ulceration, secondary glaucoma, complicated cataract

Clinical picture of alkali injury

Grading of chemical burns

Irrigation with normal saline or balanced salt solution atleast for 30mins or till ph becomes normal.water can be used if not available

Removal of retained particulate matter

Debridment of necrotic corenal epith for proper epithelixations

Immediate treatment of chemical burns

first week-prophylcatic antibiotic drops, topical cycloplegics, steroids

2md-3rd week-nsaids instead for steroids

after 3rd weeek- steroids again, ascorbic acid, citric acid, tetracyclines, tear substitutes, preservation of symblepharon formation

Subsequent treatment for chemical burns

Limbal stem cell transplantation

Amniotic membrane grafting

COrneal transplantaiton

division of symblepharon

Surgical methods for chemical injuries

FLoor of the orbit and medial wall

posteromedial portion

Blow out fracture most commonly involved wall

Diplopia, enophthalmos, orbital and lid emphysema, infraorbital nerve hopesthesia, tear drop sign

Blow out frracture clincal features

degenerative changes produced by an iron foreign body

rusty oval deposits arranged radially around the ant epith anda capsule of lens—pathognomic

iris-stained greenish and later reddish brown

retina—-pigmentary degeneration

degeneration of TM-secondary open angle glaucoma

Siderosis bulbi

due to copper iofb

kayser-fleischner ring- gilden brown ring due to deposition of copper in the persipheral parts of DM of cornea

Sunflower cataract-posteriot capsule of lens ma deposition

retina-golden plaques at posterior pole reflect light with a metalli sheen

Chalcosis

Management of blow out fracture