TASHKENT MEDICAL ACADEMY DEPARTMENT OF EYE DISEASES
Theme Injuries of an organ of vision Purpose of the lesson To teach to future general practitioner etiology, pathogenesis, clinics, diagnostics, treatment and prophylaxis of ocular traumas and show its importance. Student should be able to
Student should know Student should be able to Clinics and treatment of non-penetrating injuries (contusions) Clinics, complications of penetrating wounds Treatment and prophylaxis Clinic symptoms of thermal and chemical burns and first aid. Sympathic inflammation, symptoms and prophylaxis Endophthalmitis and panophthalmitis. GP tactics and clinics. Define tactics of management of patients with ocular traumas and burns Interpretation of the results of laboratory tests and instrumental examinations in patients with ocular burns Consultation of patients with ocular traumas Diagnostics of fractures of orbital bones Differential diagnostics of different kinds of ocular burns First aid to patients with ocular burns introduction The organ of vision is so arranged, that even the most insignificant injuries can lead to decrease of visual functions and even to blindness. Results of the analysis of injuries of an organ of vision show that more than 40% of complications after injuries is connected with the wrong evacuation of patients(Gundorov R.., Grishina V.., Polyakova ..). introduction Contusions Penetrating wounds Non penetrating wounds
Injuries of an eyeball and surrounding tissues : Contusions Penetrating wounds Non penetrating wounds Burns Not penetrating wounds
introduction In our Republic the quantity of eye injuries meets at 1-4 on 1000 population. Burns Penetrating wounds 6 2 10 % Not penetrating wounds 80 Contusions Contusions of soft tissues and orbit
By localization of a trauma : Contusions of soft tissues of an orbit The closed fractures of bones of an orbit On severity: Easy (I) Average (II) Heavy (III) The heaviest (IV) Contusions of soft tissues
Symptoms: - Subconjunctival hemorrhages - The expressed hematoma of eyelids - Restriction of the movement of an eyeball Fractures of bones of an orbit
Damage mechanism lower wall of an orbit Symptoms: - Diplopi - Enoftalm (and) Movement restriction eyeball up (b) Fractures of bones of an orbit
b c a) Change of a medial wall of an orbit (emphysema of eyelids) b) Change of external and lower walls of an orbit on the right c) Change of a upper wall of an orbit, hematoma of eyelids Tactics of fist aid First aid at injuries of surrounding soft tissues:to place to trauma imposing of cold for 1-2 hours (ice, wet towel wipes). Maintaining haemostatic vasoconstrictive preparations (Vikasol, vitamin K, ascorutin, calcium chloride of 10%). Immediately direct to ophthalmologist. Eyeball contusions By severity: Easy an absolute recovery Average small residual signs the functions which aren't influencing on vision Severe significant morphological and functional violations are observed The most severe Rough morphological changes, loss of functions Eyeball contusions Mechanism of contusions of an eyeball (scheme) Eyeball contusions Clinical signs: Subconjunctival hemorrhages
Cornea erosion Hemorrhages in the anterior camera (hyphema) Hemorrhages in a vitreous body (haemophthalmos) Trembling of an iris (iridodenesis) Expansions of a pupil (change of a form) Partial (subluxation) or full (luxation) dislocation of lens Separation or rupture of an iris (iridodialysis) Rupture of chorioid and retina Retinal detachment Lesion of an optic nerve Eyeball contusions Pupil synechia Hypostasis of a cornea, hyphema Eyeball contusions Lens dislocation in the anterior chamber
Iridodialisis from a root Lens dislocation in the anterior chamber Eyeball contusions Rupture of chorioid
Traumatic rupture of chorioid, partial haemophthalmus Eyeball contusions Traumatic rupture of an optic nerve
Traumatic detachment of a retina Eyeball contusions Contusion of an eyeball of the IV degree, destruction of an eyeball Tactics of the first aid
Instillation of antibacterial or sulphanilamyde eye drops in conjunctival bag Anesthesia (local and general) Easy aseptic bandage Immediately direct to the ophthalmologist Wounds of surrounding tissues
By localization: Wounds of eyelids Wounds of lacrimal ways Foreign bodies of an orbit of upper and lower eyelids
Wounds century The fragmentary wound of a lower eyelid The fragmentary wound of upper and lower eyelids Wounds of lacrimal pathways
Separation of a lower eyelid with destruction of lacrimal canalis Foreign matter of an orbit
Foreign body (tree) is located in orbit and trellised bosoms on the right (MR-the tomogram). Tactics of the first aid
Introduction of an antitetanic anatoxin Wash of wound with disinfecting solutions Parenteral introduction of antibiotics Easy aseptic bandage Immediately direct to ophthalmologist Wounds of an eyeball By localization: Wounds of cornea
Wounds of sclera Corneoscleral wounds By relation of integrity of an external cover of an eyeball Penetrating wounds Not penetrating wounds The penetrating wounds share: With an intraocular foreign body With loss of internal layers Wounds of an eyeball Penetrating wound of cornea, absence of the anterior chamber Penetrating wound ofcornea, anterior camera is present Wounds of an eyeball Penetrating wound of cornea with loss of an iris
Penetrating wound of cornea complicated bytraumatic cataract Wounds of an eyeball Penetrating wound of sclera with loss of iris
Corneoscleral wound with a foreign body. Penetrating wound of sclera with a foreign body in a wound.
Wounds of an eyeball Penetrating wound of sclera with a foreign body in a wound. Penetrating wound of cornea with the adapted edges and foreign body in the anterior chamber Tactics of the first aid
Introduction of an antitetanic anatoksin Washings of a wound disinfecting solutions Parenteral introduction of antibiotics Binocular aseptic bandage Immediately direct to ophthalmologist Treatment tactics Conducting the qualified help in conditions of clinic: Orbit X-ray analysis in forward and lateral projections Orbit X-ray analysis by Komberg Baltin Primary surgical processing of wounds Carrying out reconstructive operations in a planned order Severe complications after penetrating wounds of an eyeball
Endophthalmitis Panophthalmitis Sympathetic ophthalmia Thermal and chemical burns of an organ of vision
Classification of burns of eyelids and conjunctiva according to degree of burns of skin other localizations The I (easy) degree a hyperemia and hypostasis The II (average) degree bubbles The III (severe) degree an ischemisation and necrotic zones The IV (heaviest) degree necrosis of tissues Thermal and chemical burns of an organ of vision
By severity: The I (easy) degree a hyperemia of eyelids and conjunctiva, hypostasis and a superficial erosion of cornea The II (average) degree deep erosion and hypostasis of cornea, ischemia of conjunctiva and limb The III (severe) degree joins cornea hypostasis in the form of "opaque glass", necrotic zones of a conjunctiva (scab) The IV (the most severe) degree a cornea in the form of "porcelain glass", a total necrosis of conjunctiva and perforation Chemical burn of a cornea of average degree.
Thermal and chemical burns of an organ of vision Chemical burn of a cornea of average degree. Chemical burn of conjunctiva of average degree. Ischemic zones of a limb. Thermal and chemical burns of an organ of vision
Chemical burn of cornea of severe degree. Chemical burn of an eyeball of the most severe degree. Thermal and chemical burns of an organ of vision
Thermal burn of average degree Thermal burn of the most severe degree Thermal and chemical burns of an organ of vision
Thermal burn of an eyeball and surrounding tissues of the heaviest degree Thermal and chemical burns of an organ of vision
Thermochemical burn of severe degree. 1 month after a burn Thermochemical burn of the heaviest degree, the complicated cataract Tactics of the first aid
Removal of the burn agent Washing of a conjunctival sac during min. Use of buttered solutions Immediately direct to the ophthalmologist In a hospital: Anesthesia Washing of lacrimal ways Introduction of an autoblood under conjunctiva At burns of heavy degree introduction of an antitetanic anatoxin Disinfecting, vitamin solutions Parenteral introduction of antibiotics Binocular aseptic bandage Prevention of injuries of an organ of vision
Prevention consists of 2 stages: The first stage, i.e. primary prevention carrying out preventive measures among the population at home, on streets, at schools, kindergartens. The second stage, i.e. secondary prevention early diagnostics, carrying out urgent actions for active complex drug and surgical treatment help to prevent dangerous complications as purulent and phacogenic uveitis, metallosis, hypotonia of an eyeball and a sympathetic ophthalmia. Questions for control Symptoms of blind traumas of an eye, diagnostics, treatment. Superficial and deep traumas of an eyeball (symptoms, complications, treatment, prevention) Thermal and chemical burns of an eye (symptoms, complications, treatment and prevention). Sympathic inflammation, reasons, symptoms, treatment and prevention. How should one perform differential diagnostics of acute iridocyclitis with acute attack of angle-closure glaucoma. Endophthalmitis and panophthalmitis (reasons, symptoms, treatment and prevention) X-ray localization of intraorbital foreign bodies Clinics and diagnostics of non-penetrating and penetrating ocular traumas. Traumas of orbit and accessorius apparatus. Prevention of ocular traumas.