INJURY OF THE VISION

ORGAN
• An injury to the eye or its surrounding
tissues is the most common cause for
attendance at an eye hospital emergency
department.
• The resultant ocular damage may be
minor or severe with loss of vision or even
the eye
• Globally, more than 500 000 blinding
injuries occur every year.
• Ocular and orbit injuries in the majority of cases
occur following sporting and domestic or motor
vehicle accidents
• Play and sport are the most common reasons of
ocular and orbital traumas of children
 Classification.
Birmingham Eye Trauma Terminology System

The double-framed boxes show the diagnoses that are used in clinical practice
 Closed-globe injury
The eyewall does not have a full-
thickness wound. Either there is
no corneal or scleral wound at
all (contusion) or is it only
partial thickness (lamellar
laceration).

Extraocular foreign bodies, abrasions,

burns, chemical injuries - close-globe
injury with lamellar laceration
 Open-globe injury
• The eyewall has a full-thickness
wound. The cornea and/or sclera
sustained a through-through
injury;
• depending on the inciting object’s
characteristics and the injury’s
circumstances, ruptures and
lacerations are distinguished;
• the choroid and the retina may
be intact, prolapsed or damaged.
 Open-globe injury
Rupture

• Full-thickness wound of the

eyewall, caused by a blunt object;
• the impact results in momentary
increase of the intraocular
pressure.

• The eyewall gives way at its

weakest point (at the impact site
or elsewhere; example: an old
cataract wound dehisces even
though the impact occurred
elsewhere);
• the actual wound is produced by
an inside-out mechanism.
 Open-globe injury
Laceration
• Full-thickness wound of the eyewall,
usually caused by a sharp object: needle,
knife, scissors or flying metallic foreign
bodies; the wound occurs at the impact
site by an outside-in mechanism.

• Penetrating injury. Single laceration of

the eyewall, usually caused by a sharp
object. No exit wound has occurred; if
more than one entrance wound is present,
each must have been caused by a
different agent.

• Intraocular foreign body injury

(IOFB).

• Perforating injury. Two full-thickness

lacerations (entrance and exit) of the
eyewall, usually caused by a sharp object
or missile. The two wounds must have
been caused by the same agent.
 Open-globe injury
Laceration

Penetrating injury. IOFB Perforating injury.

 Closed-globe
injury.
Clinical manifestations

Orbit

Carotid
Blow-out Orbital Foreign
cavernous
fracture haematoma bodies
fistula
 FRACTURES OF THE ORBIT
• Blow-out fracture of medial wall
• Roof fracture
• Lateral wall fracture
• Blow-out fracture of orbital floor
 Eye lids

Enormous Avulsion
swelling of the Foreign
Haematoma
and lower lid bodies
ecchymosis
 Conjunctiva

Subconjunctival Conjunctival Conjunctival

haemorrhage laceration foreign bodies
 Cornea

blood
Stromal partial foreign
Abrasions staining
oedema rupture bodies
of cornea
Corneal foreign
bodies
To Remove a Corneal FB Using a
Needle
 Anterior chamber

Changes
Hyphema
of the deep
 Anterior uvea

Tear angle
Iridodialysis of the Iridoschisis
iris sphincter recession
 Lens

Cataract
(anterior or Subluxation or
Vossius ring
posterior luxation
subcapsular)
 Vitreous

posterior
vitreous hemorrhage
detachment
 Retinae

Macular oedema
hemorrhages Berlin’s oedema Retinal dialysis
or holes
 Optic nerve

Traumatic Avulsion
optic neuropathy
 Burns

Chemical Thermal UV burns

Alkaly Acid
 Chemical Burns

• The severity of the injury depends on the

agent, its concentration, and the duration
of exposure.
• Alkali burns cause greater damage than
acid burns.
• Clinical features. The acute phase is
associated initially with a varying degree of
loss of vision, corneal syndrome, changes
of eye lids
Roper-Hall classification
Epithelial damage
 Treatment of chemical
burns
• Prophylaxis of shock - local and systemic
analgesia.
• Mechanical removing the pieces of
damage matter with turning out of upper
lid
• Profuse irrigation with water, BSS and
antiseptic solutions
• Local and systemic antibacterial drugs
• Tetanus prophylaxis
• Ointment or oil for prophylaxis of
symblepharon
• The skin is treated with spray (Panthenol,
Levamisol, etc.).
 Complications
• Corneal opacity
• Symblepharon
• Recurrent corneal ulceration
• Complicated cataract
• Secondary glaucoma
 Thermal Injuries

These are usually caused by fire,

or hot fluids. The main brunt of
such injuries lies on the lids.
Conjunctiva and cornea may be
affected in severe cases
In case of thermal burns there is
no necessity to wash the eyes.
• All other procedures are similar
to those as in chemical burns.
 Ultraviolet (UV) burns

Etiology:
• welding without proper eye protection,
• exposure to high-altitude sunlight,
• sunlight reflected of snow when skiing at high altitudes on a
sunny day.
• Symptoms typically manifest themselves after a latency
period of six to eight hours. This causes patients to seek the
aid of an ophthalmologist or eye clinic in the middle of the
night, complaining of “acute blindness” accompanied by
corneal syndrom.
• examination will reveal epithelial edema and superficial
punctate keratitis or erosion in the palpebral fissure.
 Treatment of UV burns
• The “blinded” patient should be instructed that
the symptoms will resolve completely under
treatment with antibiotic ointment within 24 to
48 hours.
• Ointment is best be applied to both eyes every
two or three hours with the patient at rest in
darkened room. The patient should be
informed that the eye ointment will not
immediately relieve pain and that eye
movements should be avoided.
• Intramuscular administration of analgesics.
• Drops anesthetic solution into the conjunctival
cavity.
 PENETRATING
INJURIES
Absolute signs of penetrating
wound :
• the presence of gaping
wound in the eye;
• protrusion of the eyeball
contents outwards;
• the presence of intraocular
foreign body
 Perforated or not?

Mesquite
thorn
puncture
Seidel test: Use concentrated fluorescein
 P0SITIVE SEIDEL

Pinpoint perforation

Leaking bleb
 Methods of localization of the foreign
body
• Slit-lamp
• X-ray - Сomberg-Baltin’s or
limbal ring metod; bone free X-
rays
• Ultrasonography
• CT Scan
 First aid in case of penetrating
wound of the cornea
• Prophylaxis of shock - local and systemic
analgesia.
• Prophylaxis of tetanus
• Prophylaxis of infection – local and
systemic antibiotics of broad spectrum
• Binocular bandage
 First aid in case of penetrating
wound of the sclera
• Prophylaxis of shock - local and systemic
analgesia.
• Prophylaxis of hemorrhages - local and
systemic stopping of bleeding.
• Prophylaxis of tetanus
• Prophylaxis of infection – local and
systemic antibiotics of broad spectrum
• Binocular bandage
The surgical management
of such injuries is directed
primarily at the restoration
of normal ocular anatomy;
the ultimate goal is to
prevent secondary
complications and
maximize the patient’s
visual prognosis.
 indications for enucleation of
wounded eye
• Primary enucleation is
performed in case of:
– crushing of the eyeball;
– when a half or more of the vitreous
body is lost.
• Later on an eye is enucleated in
case of:
• Recurrence sympathetic
inflammation of healthy eye;
• painful secondary glaucoma on
the blind eye;
• atrophy of the eyeball.
 Complications
• Infection: purulent iridocyclitis,
endophthalmitis,
panophthalmitis
• Metallosis: Siderosis and
chalcosis
• Sympathetic ophthalmitis
• Traumatic cataract
• Secondary glaucoma
• Retinal detachment
• Phthisis bulbi
 clinical features of chalcosis
bulbi (copper foreign body)
• Cornea- Kayser Fleisher's ring (a golden
brown ring at the level of descemet's
membrane).
• anterior sun flower cataract.
• green discoloration of the iris
• yellow retinal plaques.
 Siderosis (ferrous
foreign body)

• Dissociated iron has a predilection for deposition in epithelial

tissue causing metabolic toxicity and cellular death.
• Siderosis may develop as early as a few days or as late as
several years after injury.
• Clinical features include injection, heterochromia (iris reddish
brown),
• secondary glaucoma,
• anterior capsular cataract - reddish ferrous deposits at lens
epithelium,
• coarse degenerative pigment dispersion, and retinal
detachment.
 is a condition in which granulomatous
uveitis attacks the sound eye after the
injury to the other eye.

 the time interval between injury and

development of sympathetic ophthalmia 4-
8 weeks.
 Onset: 5 days to 66 years after
penetrating trauma
 Onset: 33% at 3 mo., <50% after 1
year
 Cause: antigen-antibody interation
 treatment of sympathetic
inflammation.
• 1. Early excision of the injured eye.
• 2. anti-inflammatory treatment (topical
and systemic steroids)
• 3. immunosuppressent drugs
• 4. topical atropine
Thank you for your attention!