Slide Guide

Appendix A
Ocular Trauma

SLIDE A1 Title Slide

Introduce the topic and explain to students that, based on their preparation for the
course, a series of questions will be asked throughout the lecture. Their active partici
pation and responses are expected.
Emphasize that this lecture summarizes the information provided throughout the
course, and that all major components will be covered in depth during individual
lectures, skill stations, and demonstrations.
Because you will use the slide show to emphasize key points, it is important to be
familiar with every slide. Proper sequencing of questions and responses facilitates an
interactive presentation.
Be sure to carefully manage the time allotted for this lecture.

SLIDE A2 Case Scenario

Emphasize the importance of obtaining information about the history of the event
(e.g., blunt or penetrating trauma or chemical exposure), medications, previous eye
surgery, and presence of contacts.
What are the initial symptoms and acuity?
How would you examine her eye?
What injuries might require emergency management and ophthalmologic consul
tation?

SLIDE A3 Objectives
These objectives relate to the lecture/interactive discussion. There may be additional
objectives related to this topic that will be covered in the skill stations and the initial
assessments. Please refer to the Student Manual for the complete list of objectives
related to this topic.

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SLIDE A4 Assessment Principles
Emphasize the importance of a systematic exam.

SLIDE A5 Outside to Inside

The principles of eye examination are to systematically move from the external
structures of the eye and proceed to the ophthalmoscopic examination.

SLIDE A6 Assessment and Management

Photograph shows globe laceration and lid injury.
Any lid injury should alert the examiner to possible underlying eye injuries.

SLIDE A7 Assessment and Management

Photograph shows a medial canthus laceration.
Consider lacrimal duct or lacrimal sac injury.

CHAPTER 8 n Slide Guide 3

SLIDE A8 Assessment and Management

Photographs show the technique for examination of the conjunctival surface of the
eyelid for injury or foreign bodies.

SLIDE A9 Assessment and Management

Photograph shows foreign body of eyelid.
Note the foreign body can be seen only when eyelid eversion technique is utilized.

SLIDE A10 Assessment and Management

Photograph shows retained foreign body corneal ulcer.
Emphasize the importance of finding foreign bodies early. If retained, they may cause
ulceration.

SLIDE A11 Assessment and Management

Photograph shows impaled foreign body.
Impaled foreign bodies should not be removed in the ED. These patients should be
referred for ophthalmological consultation.

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SLIDE A12 Assessment and Management
Photograph shows fluorescein stain and abrasion.
Fluorescein is adsorbed to injured cells.
Fluorescein and blue light facilitate identification of corneal injuries.

SLIDE A13 Assessment and Management

Photographs show corneal foreign bodies.
Corneal foreign bodies may be removed with irrigation with a balanced salt solution.
Topical anesthetic will aid in pain control and thus examination and removal.

SLIDE A14 Assessment and Management

Eye patches are optional.
Studies show no advantage in patient comfort or time to healing.

SLIDE A15 Assessment and Management

Photograph shows hyphema.
Blood in the anterior chamber indicates severe ocular trauma.
7% of patients with hyphema will get glaucoma.

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SLIDE A16 Assessment and Management

Photograph shows iridodialysis, which is disruption of the iris from the ciliary body.

SLIDE A17 Assessment and Management

Photograph shows traumatic cataract.
Lens contusion may lead to later opacification and cataract formation.

SLIDE A18 Assessment and Management

Photograph shows subluxed lens in anterior chamber.
Blunt trauma can cause disruption of the zonular fibers that encircle the lens, resulting
in subluxation.

SLIDE A19 Assessment and Management

Photograph shows vitreous hemorrhage.
Tear of retinal vessels may be seen in the vitreous.
Usually causes profound vision loss.
Doctor may not be able to do funduscopic exam.

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SLIDE A20 Assessment and Management
Photograph shows retinal hemorrhage.
Blunt trauma may cause hemorrhage within the retina.
Retinal detachment may be a late sequela.
Visual impairment may occur if the macula is involved.

SLIDE A21 Assessment and Management

Photographs show anterior globe rupture.
Minimize manipulation of the eye to prevent further injury.
Patch this condition with sterile dressing and eye shield.

SLIDE A22 Assessment and Management

Photograph shows samples of eye dressings.
Eye dressings dont help with corneal abrasions, but should be used with more serious
ocular injuries.

SLIDE A23 Assessment and Management

Photographs show intraocular foreign body in the anterior chamber.
This condition requires ophthalmologic consultation for removal in the operating
theater.

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SLIDE A24 Assessment and Management

Photograph shows intraocular foreign body.

SLIDE A25 Assessment and Management

Photograph shows alkali burns.
Alkali burns cause more severe injury than acid burns and can lead to ocular opacifica
tion.
Treat with copious and continuous irrigation.

SLIDE A26 Assessment and Management

Photograph shows orbital blow-out fracture.
Fracture of the bones of the socket may lead to muscular entrapment within the frag
ments, or herniation of the periocular tissues into the maxillary sinus, leading to later
enophthalmos.
Operative treatment may be delayed for up to two weeks.

SLIDE A27 Assessment and Management

Radiograph shows orbit and maxillary sinus fractures.
CT scan of the face with coronal reconstruction is encouraged.
The orbital floor is not well visualized on axial cuts.

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SLIDE A28 Assessment and Management
Photograph shows retrobulbar hematoma
Immediate treatment is necessary to prevent blindness.
This is a true ophthalmologic emergency.

SLIDE A29 Case Scenario

Revisit the Case Scenario that was presented at the beginning of the slide set to give
students the opportunity to apply what theyve learned in this lesson.

SLIDE A30 Questions

Allow for adequate time for additional questions from the students and further discus
sion before proceeding to the summary slide.

SLIDE A31 Summary

These summary points relate to the lecture/interactive discussion. Please refer to the
Student Manual for the complete Summary related to this topic.