Eye Department

Queen Elizabeth Hospital

Important topic – common, dangerous but good
recovery if diagnosed promptly and treated
accordingly before referral.
Demonstrates importance of lectures and practical
stations
Bad outcome if sent home with CMC and asked to
come back in a week.
Mechanical Injury (most common)
 Concussion/ blunt trauma/ contusion
 Perforating/ penetrating injury
 Retained foreign body
Chemical Burns
Thermal Burns
Electrical Injury
Radiation Injury
Simple edema,bruises
Emphysema
Hematoma
Management - cold compress, Prolase, suture if
needed, antibiotics
Subconjunctival hemorrhage
Self resolving.
Tears rarely require suturing
Abrasions.
Management: - mydriatics, pad ,bandage
 prevent secondary infection and corneal opacity
Rarely corneal rupture
Corneal staining & Glaucoma,
Uveitis
Management:
 Rest
 Antiglaucoma treatment
 Mydriatics
 May need evacuation
 Watch for rebleed
 Hyphema Classification
Grade Size of Hyphaema

0 No layer of blood, circulating blood

only

I Less then 1/3

II 1/3 to ½

III ½ to less than total

IV Total
Tough fibrous layer
Can cause tears and rupture if trauma excessive
Mx - scleral repair T&S
If too severe (contents of eye prolapsing) -
enucleation
Child - torn muscle attachments and eyeball
expulsion from the orbit
Muscle damage, sphincter tear, damaged
parasympathethic motor fibers
Iridodialysis
Mydriasis
Management
 Usually conservative
 Pilocarpine 2%
Subluxation, Dislocation
Traumatic cataract
Lens rupture
Vossius’s ring
Can cause secondary glaucoma and uveitis
Management: conservative,ECCE, ICCE
lensectomy
Vitreous hemorrhage
Ciliary vessels and retinal vessels may tear and bleed
Eventual spontaneous resorbtion but may not clear
totally
Retinal hemorrhages
Commotio retinae (retinal edema)
 May form macular hole
Retinal tear - etiology
Retinal detachment
Management –
 Local laser
 Encirclage, scleral buckling, subretinal fluid
drainage
Etiology
Optic nerve compression, stretching
Optic nerve avulsion
Symptoms
Fundus: disc swelling, optic pallor
May be full of blood
Blowout fracture - Medial wall, Floor of orbit
Entrapped eye ball, sunken, impaired motility
Management- if significant, may require
reconstructive surgery
Can affect any part of the eye
Lid tear - ptosis (levator damage)
- Lacrimal involvement
- Margin involvement
Scleral perforation
Limbal tear
Corneal perforation
Any penetrating injury may cause iris prolapse
Management - repair, reduction, or excision
Toilet and suturing
Lens - rupture - glaucoma, cataract, iridocyclitis
 Treat accordingly
High risk of introducing infective agents -
endopthalmitis.
 Management - Intensive antibiotic therapy
 Intravitreal antibiotics
 Poor prognosis.

Sympathetic ophthalmitis (panuveitis) exciting

eye, sympathising eye weeks to months
 Management - intensive steroids
Shape
EOM
Shallow AC
Irregular pupils/ iris prolapse
Vitreous
Laceration
Eye Shield
NBM + drip
IV antibiotics
Orbit /ocular Xray
Orbit /ocular CTscan
GA assessment CXR,
 ECG
FBC BUNSE RBS
Very Urgent
 Chemical Injury
 Central retinal artery occlusion
Urgent
 Penetrating eye injury/ perforated globe
 Traumatic complications
 Fresh retinal detachment
 Ocular infections
 Acute angle closure glaucoma
Injury depends on properties of
chemical.
Strong alkaline (NaOH, NH3)
penetrates cornea rapidly
Acic causes necrosis of the
corneal and conj. epithelium
Immediate treatment
 irrigate with NS
 evert eyelid and clean fornix
 debride necrotic epithelium
 mydriatic agent, topical steriods
 Ideally monitor with PH strips.
Symblepharon
Corneal scar
Band keratopathy
Keratoconjunctivitis sicca
Narrow arterioles
Optic disc and retinal pallor
Cherry red spot at fovea
Emboli seen – 20%

CHECK FOR:VA, RAPD,

fundoscopy
Causes –Embolization
- Vaso-obliteration
 Irreversible retinal damage occurs in 90-100 min
No evidence showing clear benefit to treatment,
but poorly studied
Suggested treatments:
 Ocular massage
 Topical -blocker, -agonist, and/or CAI to  IOP
 95% O2/5% CO2
 Anterior chamber paracentesis (by opthalmologist)
Penetrating injury
Scleral perforation
Limbal tear
Corneal perforation
Extra or intraoccular
Extraoccular - conjunctiva, cornea or sclera
 Foreign body - trauma, welding
 If forceful, may lodge deep in tissue
Intraocular foreign bodies require immediate
ophthalmological attention
 Penetrating injury
 Grass cutting
Direct visualisation with slitlamp,
fundoscope
 evert eyelid
Xray orbit
U/S eye (radiolucent material and
hyphaema)
If superficial external FB, remove with spud, topical
antibiotics, eyepad

Internal FB: Intraoccular - magnet, repair, ECCE,

vitreoretinal surgery
Beware endopthalmitis
Inert - plastic, glass
Fibrotic changes - lead, aluminium
Degenerative changes - iron ,copper
 Iron - disseminates and infiltrates soft tissue causing
siderosis bulbi -eventual tissue atrophy, diminished
vision, poor night vision
 Stained iris
 Keratitis
 Corneal ulcer
 Infective uveitis
 Endopthalmitis
 Differentiate from conjunctivitis

 Unilateral

 Red and painful eye

 decreased vision

 purulent discharge

 corneal opacity

 EMERGENCY referral
Bacterial: Neisseria gonorrhoeae,
Staphylococcus Aureus, Streptococcus
pneumoniae,
Pseudomonas
Chlamydia

Viruses : Herpes
Swollen lids,purulent exudate,”beefy-red”
conjunctiva and conjunctival oedema

gonococcal organism can penetrate intact corneal

epithelium

producing ulceration and perforation if treatment

delayed

URGENT ophthalmological referral

Affects children

Diffentiate between

preorbital /preseptal

cellulitis:
Observe VA, pupils and

motility - normal with

no proptosis
Red,swollen lids and conjunctiva
periorbital area: relatively uninflammed
ocular motility: impaired with pain on eye
movements
proptosis
optic nerve involvement : decreased vision, RAPD,
optic disc oedema
True medical ocular emergency

Vision and life-threatening potential

Prompt consultation with Ophthalmologist

Treatment:
 systemic antibiotics
 warm compresses
Hospitalization

Stat eye consultation

Blood culture

Orbital / brain CT scan

IV antibiotics stat : Staphylococcus, Streptococcus,
H. influenzae

Surgical debridement if fungus, no improvement

or subperiosteal abscess

Complications: cavernous sinus thrombosis,

meningitis
Outflow of aqueus from anterior chamber is suddenly

blocked in susceptible individuals

attack : dilation of pupil in dim light / after dilating

drops / emotional stress

Severe ocular pain

frontal headache

blurred vision with haloes seen around lights

nausea

vomiting
Circumcorneal injection

Pupil : mid-dilated and oval

Cornea: cloudy

IOP : higher

Usually ONE eye only

VA
IOP
RAPD
+/-Fundoscopy
Pilocarpine 2% every 15 minutes for 2 hrs

IV Acetazolamide 500 mg

Timolol eye drops

Steroid eye drops

Retinal tear – etiology, signs and symptoms
Check VA, RAPD fundoscopy
Management –
 Local laser
 Encirclage, scleral buckling, subretinal fluid
drainage
Due to lagopthalmos
Symptomatically similar to dry eyes
incomplete eyelid closure during blinking or
sleep
may result from Bell’s palsy,scarred or
malpositioned eyelids or thyroid exophthalmos
Resultant scar or corneal ulcer
Lubricating solutions

Ointments

Avoid patching: corneal abrasions

Taping at night may help

Severe cases- refer to Ophthalomologist for

surgical correction eg tarsorrhaphy

Thank you