Ocular Trauma

Remember ADT; Analgesia; topical NSAIDs; Review daily and no contact lens use until healedCycloplegics: if severe pain (ciliary muscle spasm)Antibiotics: if large / potentially dirtyOpthalmology review if: plant scratch as high risk of fungal infection; large central epithelial defect

Corneal Abrasion

Hyphaema

Consider lens subluxation and retinal injury; most clear in 1-2 days; good prognosis if <1/3 chamberExamination: visual acuity (in 50%); somnolenceComplications: glaucoma (in 7%; may cause iron pigment staining of cornea); rebleed (occurs in 10% on day 3-5, more common in children); corneal opacificationManagment: refer to opthalmology; eye shield and eye rest (no reading, TV °etc…); bed rest with head elevated 30° until blood completely cleared; analgesia, cycloplegics, acetazolamide / timolol if intraocular pressure; avoid aspirin and other NSAIDs

Vitreous Haemorrhage

Bleeding from normal / disease / abnormal new retinal vessels, traumaSymptoms: floaters, cobwebbing, visual haze / lossManagement: urgent opthalmology

Traumatic Iritis

Occurs after days; photophobia and deep eye pain; cells and flare in anterior chamber; treat with cycloplegics and steroid drops

Corneal Ulcer

Bacterial superinfectionRisk Factors: contact lenses (pseudomonas), diabetes, immunocompromiseSigns: White/grey spot on cornea; central lobulated mass with surrounding fluorescein uptake; hypopyon (soupy = Pseudomonas, solid = staph/strep)Management: Opthalmology review, fortified top Abx

Corneal Erosion

Abrasion without history of trauma; can be infective; more in low humidity and high altitude; due to weakness of corneal basement membrane; symptom onset on wakening; 50% have adherant flap of corneaManagement: Urgent opthalmology reviw, topical NSAIDs, debride flap, 0/9% saline drops for 3 months to prevent recurrence

Ocular Foreign Body

Remove; topical antibiotics; avoid contact lenses until healed; review 24-36hrs; rust ring may require removal over a few daysOpthalmology review if: can’t remove FB, worsening / recurrent symptoms, rust ring overlying pupil;

Penetrating Eye Trauma

Usually from hammer/chisel, or violent blunt injury (globe rupture = ocular emergency)Examination: collapsed globe; visual acuity (60% will have acuity better than 6/12); shallow anterior chamber; prolapsed tissue; irregular pupil; coloured spot of choroid visible on sclera; chemosis; visible laceration; bullous raised subconjunctival haemorrhage; intraocular pressure; cloudy lens; Seidel test (running of flourescein)In globe rupture: dark uveal tissue exposed at limbus, distorted pupil, visual acuity, subconjunctival haemorrhage with swelling/chemosisInvestigations: CT; USS (high sensitivity and specificity)Management: shield; antiemetics; avoid topical medications; IV cephalothin and gentamicin; ADT, keep NBM, sit 30° head up, benzodiazepines if agitated; look for proptosis (need to do urgent lateral canthotomy); If non-penetrating conjunctival laceration <1cm, will usually heal without intervention

Eyelid Laceration

Beware if: involves palpebral ligament, lacrimal apparatus, lid margins, tarsal plate (if <1mm, will heal alone), levator palpebrae within 6-8mm of medial canthus (canalicular system) ptosis

Lens Subluxation

More common in Marfan’s syndrome; blurred vision if complete dislocation; quivering of iris when eye movedManagement: OT

Retrobulbar Haematoma

Blood accumulates behind globe proptosis, ischaemia of optic nerve ( fixed dilated pupil), visual lossManagement: urgent lateral canthotomy

Lateral Canthotomy