Ocular Trauma
Corneal
abrasion
Traumatic
Iritis
Corneal ulcers
Corneal
Erosion
Ocular FB
Penetrating
trauma
Remember ADT
Analgesia; topical NSAIDs
Cycloplegics: if severe pain (ciliary muscle spasm)
Abx: if large / potentially dirty
Review daily and no contact lens use until healed
Opthalmology review if: plant scratch as high risk of fungal infection; large central epithelial defect
Occurs after days; photophobia and deep eye pain; cells and flare in ant chamber; trt with cycloplegics and steroid
drops
Bacterial superinfection; pseudomonas in contact lens wearers; other RF = DM, immunocomp
White/grey spot on cornea; central lobulated mass with surrounding fluorescein uptake; hypopyon (soupy =
Pseudomonas, solid = staph/strep)
Opthalmology review, fortified top Abx
Abrasion without history of trauma; can be infective; more in low humidity and high altitude; due to weakness of
corneal BM; Sx onset on wakening; 50% have adherant flap of cornea
Urgent opthalmology reviw, topical NSAIDs, debride flap, N saline drops for 3/12 to prevent recurrence
Remove; Abx top; avoid contact lenses until healed; review 24-36hrs; opthalmology review if can’t remove FB,
worsening Sx, recurrent Sx, rust ring overlying pupil; rust ring may require removal over a few days
Usually from hammer/chisel, or violent blunt inj (globe rupture = ocular emergency)
OE: collapsed globe; decr VA (60% will have acuity better than 6/12); shallow ant chamber; prolapsed tissue;
irregular pupil; coloured spot of choroid visible on sclera; chemosis; visible laceration; small subconjunctival haem;
decr Iop; cloudy lens; Seidel test (running of flourescein); bullous, raised subconjunctival haem
In globe rupture: dark uveal tissue exposed at limbus, distorted pupil, decr VA, subconjunctival haem with
swelling/chemosis
Ix: CT; USS (high sens and spec)
shield;
IV cephalothin and gent
Mng:
antiemetics; avoid topical meds;
; ADT, keep
NBM, sit 30deg head up, benzo’s if agitated; look for proptosis and need to do urgent lateral canthotomy
Eyelid lac
Hyphaema
Vitreous
haem
Lens
subluxation
Retrobulbar
haematoma
If non-penetrating conjunctival lac <1cm – will usually heal without intervention
Beware if: palpebral ligament, lacrimal apparatus, lid margoins, ptosis, tarsal plate involved (if <1mm, will heal
alone), levator palpebrae, within 6-8mm of medial canthus (canalicular system)
Consider lens subluxation and retinal inj; most clear in 1-2/7; good prognosis if <1/3 chamber
OE: decr VA (in 50%); somnolence
Complications: glaucoma (in 7%; may cause Fe pigment staining of cornea); rebleed (occurs in 10% on D35, more common in children); corneal opacification
Mng: refer opthalmology; eye shield and eye rest (no reading, TV etc…); bed rest with head elevated 30deg until
blood completely cleared; analgesia, cycloplegics, acetazolamide / timolol if incr Iop; avoid aspirin and other NSAIDs
Bleeding from normal / disease / abnormal new retinal vessels, trauma
Sx: floaters, cobwebbing, visual haze / loss
Mng: urgent opthalmology
More common in Marfans; blurred vision if complete dislocation; quivering of iris when eye moved
Mng: OT
Blood accumulates behind globe  proptosis, ischaemia of ON ( fixed dilated pupil), visual loss
Mng: urgent lateral canthotomy
Notes from: