This document discusses red eye and ocular trauma from the Department of Ophthalmology at the University of Arizona. It covers both non-vision threatening disorders like subconjunctival hemorrhage and conjunctivitis, as well as vision-threatening issues such as iritis, corneal ulcers, glaucoma and endophthalmitis. Trauma is explored including hyphemas, intraocular foreign bodies, orbital fractures and complications like retinal detachments. Treatment approaches are presented for various conditions along with thanks to contributors.
Copyright:
Attribution Non-Commercial (BY-NC)
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Download as PPT, PDF, TXT or read online from Scribd
This document discusses red eye and ocular trauma from the Department of Ophthalmology at the University of Arizona. It covers both non-vision threatening disorders like subconjunctival hemorrhage and conjunctivitis, as well as vision-threatening issues such as iritis, corneal ulcers, glaucoma and endophthalmitis. Trauma is explored including hyphemas, intraocular foreign bodies, orbital fractures and complications like retinal detachments. Treatment approaches are presented for various conditions along with thanks to contributors.
This document discusses red eye and ocular trauma from the Department of Ophthalmology at the University of Arizona. It covers both non-vision threatening disorders like subconjunctival hemorrhage and conjunctivitis, as well as vision-threatening issues such as iritis, corneal ulcers, glaucoma and endophthalmitis. Trauma is explored including hyphemas, intraocular foreign bodies, orbital fractures and complications like retinal detachments. Treatment approaches are presented for various conditions along with thanks to contributors.
Copyright:
Attribution Non-Commercial (BY-NC)
Available Formats
Download as PPT, PDF, TXT or read online from Scribd
This document discusses red eye and ocular trauma from the Department of Ophthalmology at the University of Arizona. It covers both non-vision threatening disorders like subconjunctival hemorrhage and conjunctivitis, as well as vision-threatening issues such as iritis, corneal ulcers, glaucoma and endophthalmitis. Trauma is explored including hyphemas, intraocular foreign bodies, orbital fractures and complications like retinal detachments. Treatment approaches are presented for various conditions along with thanks to contributors.
Copyright:
Attribution Non-Commercial (BY-NC)
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Download as PPT, PDF, TXT or read online from Scribd
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RED EYE AND OCULAR TRAUMA
DEPARTMENT OF OPHTHALMOLOGY UNIVERSITY OF ARIZONA
v. 5.0 October 6, 2009
Thanks to all who contributed to this presentation Special thanks to Lisa Chan MD Kevin Reilly MD Jason Levine MD
50+ y.o. Severe eye pain Blurred vision Red eye Headache/nausea Corneal edema
Mid-dilated,
fixed
pupil Glaukomflecken Iris atrophy Severe anterior chamber inflammation
Angle closure attack!
Severe pain Blurred vision
Mid-dilated, fixed pupil
Hazy cornea
RED EYE (VISION-THREATENING DISORDERS)
Preseptal/orbital cellulitis
Orbital Cellulitis
Severe pain Proptosis Limited EOMs Conjunctival congestion
Diabetic?
Frontal, ethmoid, maxillary and orbital abscesses
RED EYE (VISION-THREATENING DISORDERS)
Endophthalmitis
Severe pain
Photophobia Poor vision Recent intraocular surgery
OCULAR TRAUMA Disruption
of globe Intraocular foreign bodies Hyphemas Orbital wall fractures Foreign bodies Corneal abrasions Complications of blunt trauma
OCULAR TRAUMA (Complications of blunt trauma)
Disruption of globe
Perforated or not?
Mesquite thorn puncture
Seidel test: Use concentrated fluorescein
P0SITIVE SEIDEL
Pinpoint perforation
Leaking bleb
OCULAR TRAUMA Perforating
trauma
The pupil is your clue
OCULAR TRAUMA Perforating
trauma
Dart puncture with eyelash
Corneal puncture wound with abscess
After 3 days of Garamycin Rx
Conjunctival flap
Three months after flap
DISASTER!
SYMPATHETIC OPHTHALMIA (BILATERAL granulomatous panuveitis after trauma) Onset: 5 days to 66 years after penetrating trauma Onset: 33% at 3 mo., <50% after 1 year Removal of injured eye after onset does not help Cause: antigen-antibody interaction
Risk: 0.015-1.9% (lowest after planned surgery)
Treatment: immunosuppressive therapy
OCULAR TRAUMA Intraocular foreign bodies Hyphemas Orbital wall fractures Foreign bodies Corneal abrasions Chemical burns Corneal lacerations
Evaluation of intraocular foreign bodies
Determine
visual acuity Examine for global integrity and degree of damage Do fundus examination Place shield over eye Call ophthalmologist
OCULAR TRAUMA
Intraocular foreign bodies
Situation worsening!
Poor visibility
Metal fragment
Complications of Blunt Trauma
Ruptures
of the globe
Hyphema Blow-out
fractures Retinal tears/detachments Glaucoma Cataract Dislocation of the lens
OCULAR TRAUMA
Hyphemas
Rubeosis
Hyphema
Layered hyphemas
Visual prognosis among traumatic hyphemas
Degree of hyphema No. of Patients 191 36 227
Percent with final acuity
>20/50 77 33 70 <20/200 16 55 22.5
Partial hyphema Total hyphema All hyphemas
8 month followup Am J Ophthal 5: 1, 1973
OCULAR TRAUMA
Orbital wall fractures
With muscle entrapment
Classic blowout fracture of orbital floor and ethmoids
OCULAR TRAUMA Orbital floor fracture Muscle entrapment
OCULAR TRAUMA
Entrapment of inferior rectus muscle following blowout fracture
OCULAR TRAUMA
Foreign bodies
RED EYE (Rule out trauma)
Foreign bodies Metallic
Organic
Corneal foreign bodies
Instruments
In-office tool
No, No
Now what?
Burr the rust!
Limit depth near the pupil
TO PATCH, OR NOT TO PATCH
Cumulative incidence of corneal healing Probability of corneal healing After 1 day After 2 days After 3 days Patched N=82 0.51 0.78 0.92 Non-patched N=81 0.60 0.83 0.98
Le Sage, et al: Annals Emerg. Med. 38: 129-134, 2001
Right
Wrong
Never patch more than 12 hours
Use antibiotic ointment
Semipressure patch
OCULAR TRAUMA Corneal
abrasions
Fingernail damage
Curling iron
Cigarette burn
Airbag abrasions
OCULAR TRAUMA
Chemical burns
Treatment of chemical burns
Start
high volume BSS irrigation Sweep fornices for retained material Determine type of chemical (alkali worse than acid) Check pH (goal is 7.0) Call ophthalmologist
BLUNT TRAUMA Retinal tears
RETINAL VISUALIZATION Limited views
Delayed Diagnosis of Traumatic Retinal Detachments
Interval between trauma and diagnosis Immediate 1 month 8 months 24 months
Cumulative percentage 12 30 50 80
BLUNT TRAUMA Retinal edema (commotio retinae)
Traumatic cataracts
Ectopia lentis
Our gratitude to everyone who contributed to this CD
