penetra ting eye injuries lt col qamar ul islam classified eye spec / asst prof afio, rawalpindi
TRANSCRIPT
PENETRAPENETRATING EYE TING EYE INJURIESINJURIES
LT COLLT COLQAMAR UL ISLAMQAMAR UL ISLAMCLASSIFIED EYE SPEC / ASST CLASSIFIED EYE SPEC / ASST PROFPROFAFIO , RAWALPINDIAFIO , RAWALPINDI
EPIDEMEOLOGYEPIDEMEOLOGY
• Ocular trauma is the leading cause of monocular blindness in people < 40 yrs of age
• Accounts for approx 50% of all ocular emergencies
• More common in males (78 - 84%)
• Usually occur at workplace
(outdoor location)
IMPACT OF OCULAR INJURYIMPACT OF OCULAR INJURY
• Physical disability
• Social dependency
• Financial implications
OCULARTRAUMA
MECHANICAL
CHEMICALTHERMAL
RADIATION
TYPES OF OCULAR INJURIESTYPES OF OCULAR INJURIES
Mechanical Ocular TraumaMechanical Ocular Trauma
Closed Globe Open Globe
ContusionLamellar
LacerationLaceration
Penetrating Perforating
Rupture
TERMINOLOGIES
CLOSED GLOBE INJURY
• Blunt trauma
• Corneoscleral wall intact
• Intraocular damage
OPEN GLOBE INJURY
• Full thickness wound
of the corneoscleral wall
CONTUSION
• Closed injury resulting from
blunt trauma
• Damage at site of impact or at
a distant site
LAMELLAR LACERATION
• Partial thickness wound
caused by sharp object
CLOSED GLOBE INJURY
RUPTURE
• Full thickness wound caused
by blunt trauma
• Globe gives way at the
weakest point
LACERATION
• Full thickness wound caused
by sharp object
• At the site of impact
OPEN GLOBE INJURY
(inside to outside) (outside to inside)
PENETRATION
• Single full thickness wound
without an exit wound
• Retained intraocular foreign
body
PERFORATION
• Two full thickness wounds
• Entry and exit
OPEN GLOBE INJURY
PENETRATING/PERFORATING OCULAR TRAUMAPENETRATING/PERFORATING OCULAR TRAUMA
• CAUSES : Assault, domestic accident (sharp obj like pen, pencil, scissors, knives, broken spectacles) disposable syringes, sport injuries, windshields of cars in RTA, mine/missile blast injuries, fire arm injuries, chopping or cutting wood, hammering metals or nails
PENETRATING/PERFORATING OCULAR TRAUMAPENETRATING/PERFORATING OCULAR TRAUMA
• MECH OF INJURY :Size of objectSpeed at the time of impactComposition of object
o SHARP OBJECT well defined laceration of globe
o FLYING F.B damage related to their kinetic energy
o RETAINED IOFB
• MECHANICAL EFFECTS• INTRODUCTION OF INFECTION
• TOXIC/CHEMICAL EFECTS
MMain ain SSymptomsymptoms/Signs/Signs• Redness of eye,
• Haemorrages
• Congestion
• Lacrimation
• Photophobia
• Raised Eyelids
• Itchy/Watery Eyes
• Blurring or Loss of Vision
• Change in Pupil Shape
• Blood or Fluid Leakage from the Eye
• Foreign Object Penetrating Eye
EEffects Of Penetrating Ocular Injuriesffects Of Penetrating Ocular Injuries
• Mechanical effects: Laceration of the conjunctiva, corneal lacerations,Vitreous haemorrage, rupture of globe, retinal tears and detachments, scarring which leads to cataract and glaucoma. And Intra ocular foriegn bodies.
• Introduction of infection: the entrance of the wound may serve as a route of entry for pyogenic bacteria,which may lead to the fromation of abscess of cornea, purulent iridocyclitis or Endophthalmitis
• Sympathetic Ophthalmitis: It is a complication of penetrating injury.
• Visual impairment and Enucleation
EEffects Of Penetrating Ocular Injuriesffects Of Penetrating Ocular Injuries
EEffects Of Penetrating Ocular Injuriesffects Of Penetrating Ocular Injuries
* In general always suspect more extensive
injury than may be readily apparent and
search carefully for any defects in the
integrity of the globe or intraocular foreign
bodies
MANAGEMENT GUIDELINESMANAGEMENT GUIDELINES
Medical Reception Centre Make the patient comfortable
Take vital signs
Assess the degree of damage
Take Visual Acuity
Torch examination
Distant Direct Ophthalmoscopy
Documentation
MANAGEMENT GUIDELINESMANAGEMENT GUIDELINES
GENERAL PRINCIPLES
• Determine the nature and extent of any life-threatening problems
• History – circumstances, timing, likely object
• Ocular examination (minimal handling)
» Eyes
» Orbits
• Application of eye pad
• Psychological (avoid negative reassurance !!!!!!!)
• Referral to eye specialist
MANAGEMENT GUIDELINESMANAGEMENT GUIDELINES
Ultrasonography
X- Ray Orbit
CT SCAN
MANAGEMENT GUIDELINESMANAGEMENT GUIDELINES
INVESTIGATIONSINVESTIGATIONS
PRINCIPLES OF SURGICAL REPAIR
• PRIMARY REPAIR» Undertaken immediately
» Preserve visual acuity
» Remove the dead and devitalized tissue
» Preserve as much normal tissue as possible
» Close any open wounds
» Prevent / treat any nidus of infection
• SECONDARY REPAIR» 10 – 14 days after primary repair
» Clear opacities of the media
» Stabilize abnormal vitreoretinal interactions
MANAGEMENT GUIDELINESMANAGEMENT GUIDELINES
• Prophylaxis of Endophthalmitis
Antibiotics
• Enucleation
(when nothing to salvage)
MANAGEMENT GUIDELINESMANAGEMENT GUIDELINES
• REMOVAL OF IOFB TECHNIQUE OF REMOVAL OF IOFB depends on :
o Chemical compositiono Locationo Size of IOFBo Clarity of mediao Phakic statuso Toxicity of IOFB
MAGNET removalFORCEPS removal
MANAGEMENT GUIDELINESMANAGEMENT GUIDELINES
Don’ts and Do’s• DO NOT flush the eye with any liquids other than saline or warm water or
even better just do not touch the eye
• DO NOT remove the object out of the eye
• DO NOT put any pressure on the eye• Do NOT rub your eye.• Reassure the person and advise against rubbing or moving their eye
as this can cause further damage• If the injury is severe, place a moist pad and loosely bandage the
eye.• Transport the patient to the nearest Hospital as fast as possible• In the case of small penetrating objects, use a cup to cover the object
and keep the person calm and lying down until help arrives.
MANAGEMENT GUIDELINESMANAGEMENT GUIDELINES
TAKE HOME MESSAGETAKE HOME MESSAGE
Anticipation of complications requiring referral
to ophthalmic surgeon
The nature and possible consequences of the
patient’s condition should be communicated to
the patient and his family as accurately and
honestly as possible
Never trivialize a condition since untoward
complications can make for a very dissatisfied
patient and a vulnerable physician
T h a n k y o
u
IMPACT OF OCULAR INJURYIMPACT OF OCULAR INJURY