TMATMADepartment of eye diseasesDepartment of eye diseases

Medical emergency in ophtalmologyMedical emergency in ophtalmology

The purpose of the training session: Ocular traumas make from 5% to 10% of all eye diseases. Due to this fact the main goal of our lecture is to convince GP in necessity of acquiring knowledge in the questions of etiology, pathogenesis, clinics, diagnostics, treatment and prophylaxis of ocular traumas.

Pedagogical objectives:• Peculiarities of management of patients with ocular traumas and eyeburns.

• Methods of rehabilitation at ocular traumas and burns.• The reasons leading to ocular traumas.• Main clinical symptoms, differential diagnosis, complications of ocular traumas and burns. • First aid at electroophthalmia.

• The symptoms of “sympathetic” ophthalmia

Learning outcomes:The student should know:•Peculiarities of tactics and management of patients with ocular traumas and eye burns

•Methods of rehabilitation at ocular traumas and eye burns

•The reasons leading to ocular traumas and eye burns

•General clinical symptoms, differential diagnosis, complications of ocular traumas and eye burns

•First aid at electroophthalmia • Symptoms of sympathetic ophthalmia

The student should be able to:• Determine tactics in patients with ocular traumas and eye burns•Perform regular examination and treatment of patients with ocular traumas and eye burns• Interpret the results of labs and instrumental methods of examination of patients with ocular traumas and eye burns. • Perform consultations of patients with ocular traumas

• Diagnose of orbital fractures • Differentiate different types of eye burns • Provide fist aid at eye burns

Types of Eye InjuryTypes of Eye Injury

There are a great variety of possible eye injuries but they tend to fit into the following There are a great variety of possible eye injuries but they tend to fit into the following basic types.basic types.

Blunt ocular traumas Blunt ocular traumas Penetrating ocular traumasPenetrating ocular traumas Non-penetrating ocular traumasNon-penetrating ocular traumas Chemical eye injuriesChemical eye injuries Minor superficial eye injuries:Minor superficial eye injuries: corneal abrasionscorneal abrasions corneal and conjunctival foreign bodiescorneal and conjunctival foreign bodies conjunctival lacerations conjunctival lacerations Eyelid injuriesEyelid injuries Orbital injuries and fracturesOrbital injuries and fractures Burns of cornea, conjunctiva and eyelidBurns of cornea, conjunctiva and eyelid

Distribution Distribution

%

26

10

80

Blunt injuries

Burns

Non-penetrating eye injuries

Penetrating eye injuries

Blunt trauma of soft tissues and orbitInjuries are divided by localization:

Blunt traumas of soft tissue and orbit

Closed fractures of orbit

Blunt traumas of soft orbital tissues

Signs:- Subconjunctival haemorrage- Haematoma of eyelids- Absence of ocular movements

Orbital Orbital fracturesfractures

signs:- diplopy- enoftalm-absence of ocular movements

Orbital Orbital fracturesfractures

a) Fractura of medial wall of the eye ( emphyzema of eyelids)b) Fracture of lateral and inferior walls of orbit of right eye с) Fracture of the superior wall of orbit, haematoma of eyelids

а

bc

First-aid tacticsFirst-aid tactics First aid for injuries of surrounding soft

tissues: on-site imposition of cold for 1-2 hours (ice, wet wipes).

Maintaining hemostatic vasoconstrictors (menadione, vitamin K, Ascorutinum calcium chloride 10%).

Immediately send to ophthalmologist.

Divided according to severity:Mild - complete recovery Medium - small residual symptoms do not

affect visual function Severe - there are large morphological

and functional disorders Very severe - Rough morphological

changes, loss of function 

Blunt injuries of eye Blunt injuries of eye (contusion)(contusion)

Blunt injuries of the eyeBlunt injuries of the eye

Mechanism of eyeball contusion Mechanism of eyeball contusion ((schematic viewschematic view))

Blunt injuries of the eyeBlunt injuries of the eye

Subconjunctival haemorrage Corneal erosionCorneal erosion Hyphaema Hyphaema Haemophthalm (vitreous haemorrhage)Haemophthalm (vitreous haemorrhage) Iridodonezis (trembling of iris)Iridodonezis (trembling of iris) MydriazisMydriazis Subluxation of lensSubluxation of lens Iridodializis (detachment or tear of the iris)Iridodializis (detachment or tear of the iris) Choroidal or retinal rupturesChoroidal or retinal ruptures Retinal detachmentRetinal detachment Avulsion of an optic nerveAvulsion of an optic nerve

SignsSigns::

Choroidal or retinal rupturesChoroidal or retinal ruptures

Oedema of the cornea and Oedema of the cornea and hyphemahyphema

Ruptura of the pupillaeRuptura of the pupillae

Blunt injuries of the eyeBlunt injuries of the eye

IridodializisIridodializis Dislocation of the lensDislocation of the lens

Blunt injuries of the eyeBlunt injuries of the eye

Choroidal ruptures and Choroidal ruptures and partial haemophthalmospartial haemophthalmos

Choroidal rupturesChoroidal ruptures

Horoidal or retinal rupturesHoroidal or retinal ruptures

Retinal detachmentRetinal detachmentTraumatic avulsion of optic Traumatic avulsion of optic nervenerve

Blunt injuries of the eyeBlunt injuries of the eye

Subconjunctival ruptures of eye

First-aid tacticsFirst-aid tactics Instillation into the conjunctival sac

of antibiotics or sulfa eye drops Anesthesia (local and general) Easy aseptic bandage Immediately send to

ophthalmologist

Injuries of surrounding tissues

Injuries of eyelids

Lacrymal ducts injuries

Foreign bodies

By localization injuries are divided into:

Injuries of eyelids

Lacerative crush wound of lower eyelid Lacerative crush wound

of upper and lower eyelids

Lacrymal ducts injuries

Laceration of the lower eyelid, with injury of lacrimal duct

Foreign bodies of the orbit

Wooden foreign body is located in the right orbit and labyrinth (MRI)

First-aid tacticsFirst-aid tactics Tetanus toxoid Washing the wound with disinfectant

solutions Parenteral (i/m) administration of

antibiotics Easy aseptic bandage Immediately send to

ophthalmologist

Wounds of an eyeballWounds of an eyeball

Divided by localizationDivided by localization::- Corneal woundsCorneal wounds- Scleral woundsScleral wounds- Corneoscleral woundsCorneoscleral wounds- By penetrating of external wallsBy penetrating of external walls- Penetrating injury Penetrating injury - Non-penetrating injury Non-penetrating injury - Penetrating injuries are divided into 2Penetrating injuries are divided into 2::- With intraocular foreign bodyWith intraocular foreign body- With exit of intraocular tissues from the woundWith exit of intraocular tissues from the wound

Wounds of an eyeballWounds of an eyeball

Penetrating injury of cornea, Penetrating injury of cornea, absence of anterior chamberabsence of anterior chamber

Penetrating injury of cornea, Penetrating injury of cornea, anterior chamber is presentanterior chamber is present

Eyeball injuriesEyeball injuries

Penetrating injury of cornea Penetrating injury of cornea with exit of iriswith exit of iris

Penetrating corneaal wound Penetrating corneaal wound complicated with lens complicated with lens opacification opacification

Eyeball woundsEyeball wounds

Penetrating wound of sclera Penetrating wound of sclera with exit of iriswith exit of iris

Corneoscleral penetrating Corneoscleral penetrating injury with foreign bodyinjury with foreign body

Injuries of an eyeballInjuries of an eyeball

Borders of cornea are Borders of cornea are adapted, penetrating wound adapted, penetrating wound with foreign body in anterior with foreign body in anterior

chamberchamber..

Penetrating scleral wound Penetrating scleral wound with foreign bodywith foreign body. .

First-aid tacticsFirst-aid tactics

Tetanus toxoidTetanus toxoid Washing the wound with disinfectant

solutions Parenteral administration of antibiotics Binocular aseptic bandage Immediately send to ophthalmologist

Treatment tacticsTreatment tactics

Performed by ophthalmologist in specialized Performed by ophthalmologist in specialized clinicsclinics::

- X-ray of the orbit in the front and lateral projections

- X-ray of orbit by Komberg – Baltin- Primary surgical treatment of wounds- Reconstructive operations routinely if necessary.

Severe complications after penetrating wounds of the eyeball

Endophthalmitis

Panophthalmitis

Sympathetic ophthalmia

Injuries of eyeballInjuries of eyeball

Thermic and chemic burns of Thermic and chemic burns of eyes eyes

I (mild) degree - redness and swellingII (average) degree – bubblesIII (severe) degree - ischemia and necrotic zoneIV (very severe) degree - necrosis

Burns of eyelids and conjunctiva are Burns of eyelids and conjunctiva are divided by severetydivided by severety

I (mild) degree I (mild) degree – – hyperemia of eye tissues, hyperemia of eye tissues, oedema, superficial corneal erosion. oedema, superficial corneal erosion.

IIII ( (mediummedium) ) degreedegree – – deep corneal erosion, deep corneal erosion, oedema, ishchemisation of conjunctiva and oedema, ishchemisation of conjunctiva and limbus area limbus area

IIIIII ( (severesevere) ) degreedegree – – in addition to the above in addition to the above mentioned corneal opacification like misted mentioned corneal opacification like misted glass in the necrotic zonesglass in the necrotic zones

IVIV ( (very severevery severe) ) degree degree – – porcelain cornea, total porcelain cornea, total necrosis of conjunctiva, perforation necrosis of conjunctiva, perforation

Classification by severetyClassification by severety::

Thermic and chemic burns of Thermic and chemic burns of eyes eyes

Thermic and chemic burns of Thermic and chemic burns of eyes eyes

Конъюнктива ўрта Конъюнктива ўрта даражали кимёвий куйиши. даражали кимёвий куйиши. Лимб сохасида ишемик қон Лимб сохасида ишемик қон

томирсиз зона.томирсиз зона.

Шох парда ўрта даражали Шох парда ўрта даражали кимёвий куйиши. кимёвий куйиши.

Thermic and chemic burns of Thermic and chemic burns of eyes eyes

. . . .

Thermic and chemic burns of Thermic and chemic burns of eyes eyes

Кўз олмаси ўта оғир кимёвий куйиши. Асоратли катаракта шох парда яраси

Кўз олмаси ўта оғир кимёвий куйиши. Асоратли шишган

катаракта, иккиламмчи глаукома.

Thermic and chemic burns of Thermic and chemic burns of eyes eyes

Very severe thermic burnVery severe thermic burn

Thermic and chemic burns of Thermic and chemic burns of eyes eyes

Very severe thermic burn of eyeball and surrounding tissues

Thermic and chemic burns of Thermic and chemic burns of eyes eyes

Very severe thermochemical burns, complicated cataract

Severe theromochemical burn of an eyeball. 1 month after the

injury.

First-aid tacticsFirst-aid tactics Removing of burn agent Washing the conjunctival sac during 10-15 minutes. Using buttered solutions Immediately send to ophthalmologist

In the hospital: Anesthesia Washing of lacrimal ducts The introduction of autologous blood under the

conjunctiva In case of severe burns, tetanus toxoid injection Disinfecting, vitamin solutions Parenteral injection of antibiotics Binocular aseptic bandage

Thermic and chemic burns of Thermic and chemic burns of eyes eyes Енгил ва ўрта даражали куйишларнинг Енгил ва ўрта даражали куйишларнинг

оқибатлари қониқарлиоқибатлари қониқарли Оғир ва ўта оғир даражали куйишлардан Оғир ва ўта оғир даражали куйишлардан

сўнг одатда пластик жаррохликни талаб сўнг одатда пластик жаррохликни талаб қиладиган чандиқли ўзгаришлар қолади.қиладиган чандиқли ўзгаришлар қолади.

Оғир ва ўта оғир даражали куйишлардан Оғир ва ўта оғир даражали куйишлардан сўнги асоратланган болаларни кўз сўнги асоратланган болаларни кўз патологиясини профилактикаси гурухига патологиясини профилактикаси гурухига киритилади ва узоқ муддат актив киритилади ва узоқ муддат актив диспансер назоратида кузатилади.диспансер назоратида кузатилади.

Acute attack of glaucomaAcute attack of glaucoma

Prophylaxis of ocular traumasProphylaxis of ocular traumas

Prevention consists of two stages:The first step, i.e. Primary prevention - preventive measures among the population at home, on the streets, in schools, kindergartens.The second stage, i.e. secondary prevention - early diagnosis, urgent measures to actively integrated medical and surgical treatment to help to prevent dangerous complications such as purulent and phacogenic uveitis, metallosis, hypotension eyeball and sympathetic ophthalmia.

Questions.1. Non-penetrating ocular traumas (contusion). Clinical features, diagnosis, treatment.2. Superficial and deep wounds of eyeball (symptoms, complications, treatment and prevention).3. Thermal and chemical eye burns (Symptoms, complications, treatment and prevention).4. Sympathetic inflammation (clinic, prevention, and treatment)5. Endophthalmitis and panophthalmitis (clinic, prevention and treatment)6. «X-ray» - the localization of foreign bodies in the eye?7. Penetrating and non-penetrating traumas of the posterior segment of the eyeball (hospital treatment)8. Prevention of orbital traumas and the auxiliary apparatus. 9. Electrophthalmia (clinical, prevention, and treatment).10. Prevention of ocular traumas.