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Ocular Trauma: Triage and Management
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Brief Epidemiology
Classification
Trauma Examination
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Case History
a) Pre-injury vision
b) Previous ocular surgery
c) Details of trauma
Visual Acuity
a) Topical anesthesia may be necessary
Externals
a) Pupils
b) EOMs
c) Cover Test/Maddox Rod Test
d) Confrontation Visual Fields
Physical examination
a) Palpate eyelids and orbital margins
b) Test forehead and cheek sensitivity
Slit-lamp examination
a) Fluorescein staining/Seidel testing
IOP
a) Deferred for open globe injuries
DFE
Necessary ancillary tests
a) Imaging studies
b) pH testing with litmus paper
Findings: From Anterior to Posterior
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Periorbital Ecchymosis
Eyelid Laceration
Chemical Burn
Subconjunctival Hemorrhage
Conjunctival Abrasion/Laceration
Corneal and Conjunctival Foreign Bodies
Corneal Abrasion
Corneal Laceration
Traumatic Iritis
Hyphema
Hemosiderosis
Angle Recession
a) Pathogenesis of Angle Recession
b) Anatomy of Angle Recession
c) Pearls for Observing Angle Recession
d) Angle Recession Glaucoma Background
(1) Early Type Angle Recession Glaucoma
(2) Late Type Angle Recession Glaucoma
(3) Very Late Angle Recession Glaucoma
Medical Treatment
Follow-up Care
Iridodialysis
Traumatic Cataract
Lens Subluxation
Lens Dislocation
a) Positioned in the Anterior Chamber
b) Positioned in the Posterior Segment
Globe Rupture
Orbital Fractures
a) Medial Wall (Ethmoidal) Fracture
b) Blow-out Fracture of the Orbital Floor
c) Trapdoor Fracture
d) Tripod (Zygomatico-complex) Fracture of the Lateral Wall
e) Orbital Roof Fracture
f) Apex (Optic Canal) Fracture
Vitreous Involvement
Intraocular Foreign Body
Commotio Retinae
a) Pathophysiology
Pre-retinal Hemorrhage
Choroidal Rupture
Traumatic Macular Hole
Purtscher’s Retinopathy
Retinal Detachment
a) Macula-on RD
b) Macula-off RD
Retrobulbar Hemorrhage
Carotid-cavernous Fistula
a) High-flow
b) Low-flow
Traumatic Optic Neuropathy
Conclusion
a) Using a systematic approach when examining for ocular trauma will
serve both the clinician and the patient alike.
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f)
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E.
References
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