Ocular trauma simplified
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Ocular trauma simplified
- 2. CLASSIFICATION BURNS & CHEMICAL INJURIES EXTRAOCULAR FB OCULAR INJURIES CONCUSSION OR BLUNT TRAUMA (CLOSED GLOBE INJURY) PENETRATING / PERFORATING INJURIES(OPEN GLOBE INJURY)
- 3. HEAT BURNS CAUSES HOT WATER STEAM HOT ASH EXPLODING POWDER MOLTEN METAL
- 4. S/S LID SWELLING CHEMOSIS SYMBLEPHERON LID CONTRACTURE- ECTROPION-EPIPHORA ENTROPION EXPOSURE KERATITIS
- 5. TREATMENT COLD COMPRESSES LOCAL ANTIBIOTIC OINT QID METHYL CELLULOSE E/D QID GLASS ROD TO PREVENT SYMBLEPHERON
- 6. CHEMICAL BURNS ALKALI BURNS ACID BURNS
- 7. ALKALI BURNS STRONG AMMONIA- NECROSIS OF CORNEA LIME BURNS- ISCHEMIA- COAGULATIVE NECROSIS OF- CONJUNCTIVA CORNEA SCLERA SYMBLEPHERON & OPAQUE CORNEA
- 8. TREATMENT COPIOUS IRRIGATION SWEEP FORNICES WITH COTTON BUD WEAK ACID-BORIC ACID,MILK,VIT C LIME BURNS-10%NEUTRAL AMM. TARTARATE, SODIUM EDTA ANTIBIOTIC OINT STEROID OINT GLASS ROD APPLICATION
- 9. ACID BURNS HCI, H2SO4 CHEMOSIS CORNEAL DAMAGE SYMBLEPHERON LOCALISE DAMAGE BY PPT. PROTEINS- LESS PENETRATING
- 10. TREATMENT WASH WITH WATER WEAK ALKALI AS 3% NaHCO3 IF EXTENSIVE CORNEAL DESTRUCTION- TREAT BY KERATOPLASTY * SUP. LAMELLAR * PENETRATING
- 11. WARFARE GASES LACRIMATORY GASES MUSTARD GAS ARSENICAL GAS
- 12. LACRIMATORY GAS ETHYL IODO ACETATE BROMO BENZYL CYNATE CHLORO ACETO PHENON SYMPTOM- IRRITATION,LACRIMATION, BLEPHEROSPASM SIGN-CHEMOSIS Rx-IRRIGATE WITH SALINE OR 2%NaCO3
- 13. MUSTARD GAS DICHLORO ETHYL SULPHIDE S/S BLEPHAROSPASM CHEMOSIS ORANGE SKIN CORNEA Rx- IRRIGATE WITH NaHCO3 EMOLIENT DROPS ANTIBIOTIC OINT DARK GLASSES
- 15. EXTRAOCULAR FB PARTICLES OF COAL,DUST EMERY,STEEL GRAINS OF CORN HUSK OF SEEDS WING OF INSECTS
- 16. CONJUNCTIVAL FB PALPEBRAL CONJ- SULCUS SUBTARSALIS FORNICES BULBAR CONJ Rx REMOVAL WITH COTTON BUD HYPODERMIC NEEDLE SNIP CONJ
- 17. CORNEAL F.B IED SYMPTOM-PAIN, LACRIMATION,PHOTOPHOBIA SIGN-MIOSIS, C.ULCER,HYPOPYON DIAGNOSIS-FLUORESCEIN STAIN Rx-4% XYLOCAINE,REMOVE WITH COTTON BUD,NEEDLE,F.BODY SPUD PAD & BANDAGE PROPHYLAXIS-FIT GUARDS ON MACHINES , PROTECTIVE GOGGLES.
- 19. CORNEA CORNEAL ABRASION DISTORTION OF CORNEAL REFLEX(PLACIDO’S DISC) FLUORESCEIN STAIN +ve RECURRENT TRAUMATIC KERATALGIA FINGER NAIL SCRATCHES FLUORESCEIN STAIN +ve ON AWAKENING,LID RUBBING Rx-E/D CIPLOX 2HRLY x 1 WK -DEBRIDEMENT+EYE PADx48 HR
- 20. RUPTURE OF DESCEMET’S MEMB STROMAL OEDEMA—DEEP OPACITY Rx-5% NaCI Sol BLOOD STAINING OF CORNEA HYPHAEMA—INCREASED IOP— ENDOTHELIAL DAMAGE—BLOOD STAINING OF CORNEA Rx- LOWER IOP - EVACUATE HYPHAEMA
- 21. SCLERA RUPTURE OF GLOBE SUDDEN & VIOLENT FORCE FALL ON PROTRUDING OBJECT SUPERONASAL TEAR OF THIN SCLERA (3-4mm POST TO LIMBUS) --Sub/Conj. DISLOCATION OF LENS Rx- CAREFUL EXAM , GA PREFFERED RETRACT LIDS,CUT CONJUNCTIVA,SEE FOR SCLERAL TEAR
- 22. SUTURE SCLERAL TEAR IF Sub/Conj. DISLOCATION OF LENS- REMOVE VITREOUS BY VITRECTOMY SUTURE SCLERA AFTER CLEARING VITREOUS FROM WOUND EXAMINE RETINA
- 23. IRIS & CILIARY BODY TRAUMATIC MIOSIS TRAUMATIC MYDRIASIS • ANTEFLEXION OF IRIS • RETROFLEXION OF IRIS • T. ANIRIDIA • IRIDODIALYSIS
- 24. • C.BODY – TORN NEAR IT’S ANT. ATTACHMENT – LONGITUDIONAL TEAR IN C. BODY – SPLIT CIRCULAR FROM RADIAL FIBRES —ANGLE RECESSION—DEEP AC— INCREASED IOP • Rx-REST – IRIDODIALYSIS-USE ATROPINE – ANCHOR IRIS EDGE WITH SILK SUTURE TO SCLERAL INCISION.
- 25. LENS • VOSSIOUS RING • CONCUSSION CATARACT – TEAR IN CAPSULE- AQUEOUS INFLOW – ROSETTE CATARACT —TOTAL CATARACT IN HRS TO FEW MONTHS. – Rx-ECCE+ PCIOL
- 26. • SUBLUXATION OF LENS – DEEP AC,IRIDODONESIS,EDGE OF LENS VISIBLE • DISLOCATION – ANT-IN AC(GLOBULE OF OIL) -MIOSIS-SPASM OF SPHINCTER -IRIDOCYCLITIS,SEC. GLAUCOMA – POST.- IN VITREOUS CAVITY -BLACK PUPIL -HIGH HYPERMETROPIA
- 27. • Rx- – AC-WIRE VECTIS EXTRACTION WITH VITRECTOMY – VITREOUS-VITRECTOMY & LENS REMOVAL BY FRAGMATOME -USE OF PFCL TO BRING LENS INTO AC
- 28. VITREOUS • VITREOUS DETACHMENT – ANT. – POST. • VIT. HAEM. – Rx- VITRECTOMY
- 29. CHOROID • RUPTURE OF CHOROID – CHOROIDAL TEAR WITH VISIBLE WHITE SCLERA – IF MACULAR INV.-SEVERE VISUAL LOSS • CHOROIDAL HAEM.
- 31. RETINA • COMMOTIO RETINAE(BERLIN’S OEDEMA) – RETINAL OEDEMA—MACULAR CYST—M. HOLE.CHERRY RED SPOT AT MACULA. • RETINAL TEARS / DIALYSIS— RD • TRAUMATIC PROLIFERATIVE CHORIORETINOPATHY
- 33. OPTIC NERVE • OPTIC ATROPHY – HAEM IN SHEATHS OF OPTIC NERVE – SHEARING FORCE OR STRETCH – NERVE CAUGHT IN FRACTURED BONE ENDS – SNAPPING OF VESSELS • AVULSION OF OPTIC NERVE
- 34. I O P • HYPOTONY • RAISED IOP – DUE TO ANGLE RECESSION – DUE TO GHOST CELL OBS OF TRABECULAR MESHWORK
- 35. PENETERATING INJURIES • IMM. TRAUMA EFFECTS • INTRODUCTION OF INFECTION • POST-TRAUMATIC IRIDOCYLITIS • SYMPATHETIC OPHTHALMITIS
- 36. INTRODUCTION OF INFECTION • PYOGENIC ORGANISM- – CORNEAL WOUND—ENTRY—RAPID NECROSIS OF CORNEA—RING ABSCESS – PSEUDOMONAS(ANAEROBIC GRAM –VE ROD)—CHEMOSIS OF CONJUNCTIVA(GREEN DISCHARGE) —RELEASE ENZYME—LIQUIFY CORNEA—HYPOPYON—ENDOPTH— PANOPTH – Rx-INTENSIVE WITH POLYMIXIN B & GENTA
- 37. • CLOSTRIDIA WELCHI – VIRULENT PANOPHTHALMITIS – BROWNISH DISCHARGE – GAS BUBBLE IN AC – Rx— PENICILLIN I/V
- 38. • CLOSTRIDIUM TETANI – CEPHALIC TETANUS – ROAD ACCIDENTS – AGRICULTURAL ACCIDENTS – Rx * IF IMMUNISED-Inj TT * IF NOT IMMUNISED-PROPHYLACTIC TREATMENT
- 39. IMMEDIATE TRAUMA EFFECTS • CONJUNCTIVA – TEAR IN CONJUNCTIVA – Rx-STITCH
- 40. • CORNEA – CORNEAL TEAR-LINEAR -LACERATED – SMALL & CENTRAL-MAY HEAL – INFECTED-Rx AS C. ULCER – LARGE TEAR-IRIS PROLAPSE • Rx-ABSCISSON / REPOSITION OF IRIS+REPAIR C.TEAR • CORNEOSCLERAL TEAR – Rx-REPAIR AFTER VITRECTOMY
- 41. • WOUNDS OF LENS(TRAUMATIC CATARACT) – ROSETTE SHAPED CATARACT -F. BODY TRACK -FLOCCULI IN AC
- 42. PENETERATING INJURIES WITH RETAINED IOFB • IOFB – MECHANICAL EFFECTS – INTRODUCTION OF INFECTION – CHEMICAL ACTION OF FB • MINUTE CHIPS OF IRON,STEEL & STONE • GLASS PARTICLES • LEAD PELLETS • COPPER PERCUSSION CAPS • WOOD SPICULES
- 43. MECHANICAL EFFECTS • CORNEAL/ SCLERAL TEAR • IRIS HOLE • CATARACT • VIT. HAEM. • RD
- 44. INFECTION • FOLLOWS INTRODUCTION OF STONE OR WOOD PIECES • FLYING METALS- STERILE AS GENERATE HEAT • Rx- REMOVAL OF FB - ANTIBIOTICS
- 45. REACTION OF OCULAR TISSUE TO FB DEPENDS ON CHEMICAL NATURE OF THE FB – NON ORGANISED MATERIAL – ORGANISED MATERIAL
- 46. NON-ORGANISED MATERIAL • INERT- GLASS,PLASTIC,PORCELAIN, GOLD,Ag,Pt & TENTALLUM • LOCAL IRRITATION—FIBROSIS • SUPPURATION-Zn,NICKEL,Hg • LOCAL REACTION-Al • MINIMAL REACTION-Pb PELLETS • DEGENERATIVE CHANGES-Fe,Cu
- 47. IRON(SIDEROSIS) • Fe++ JOINS CELLULAR PROTEINS —KILLS CELLS—ATROPHY – LENS-DEPOSITS ON ANT CAP. -CATARACT – IRIS-STAINED GREENISH—RED BROWN – RETINA-PIGMENTARY DYSTROPHY -DROP IN VA—BLIND – INCREASED IOP
- 48. COPPER/BRASS(CHALCOSIS) • PURE Cu-SUPPURATION w/a ALLOY-MILD Rxn—CHALCOSIS • Cu++ ELECTROLYTIC DISSO.— DEPOSITED ON MEMB. – CORNEA-GOLDEN BROWN KF RING – LENS-SUNFLOWER CATARACT – RETINA – GOLDEN PLAQUES AT POST. POLE, NO DEG. CHANGES,GOOD VA
- 49. ORGANISED MATERIALS • WOOD & VEG MATTER— PROLIFERATIVE Rxn—GIANT CELL • EYE LASHES—AC, PROL. OF ROOT HAIR—I/O CYSTS • CATERPILLAR HAIR—SEVERE IRIDOCYCLITIS— GRANULOMATOUS NODULES (OPHTHALMIA NODOSA)
- 50. DIAGNOSIS OF IOFB • DETAILED ANT. SEG.& FUNDUS EXAM • X-RAY • USG • CT • BURMAN LOCATOR & DETECTOR
- 51. MANAGEMENT OF IOFB • REMOVAL UNLESS – INERT & STERILE – LITTLE DAMAGE TO VISION – REMOVAL PROCESS IS DETRIMENTAL TO GOOD VA • ANT. SEGMENT-REMOVE THRU ANT.ROUTE • IN LENS- REMOVE LENS
- 52. • POST. SEGMENT – 3 PORT PARS PLANA VITRECTOMY WITH IOFB FORCEPS, DIAMOND TIP FB FORCEPS, IO MAGNET – PROGNOSIS- NOT GOOD • POST TRAUMATIC IRIDOCYCLITIS – Rx-STEROIDS- LOCAL/ SYSTEMIC
- 53. SYMPATHETIC OPHTHALMITIS • INFLAMMATION OF SOUND EYE AFTER INCARCERATION OF IRIS, CB,LENS CAPSULE • CILIARY ZONE IS DANGEROUS • IF SUPPURATION NO S.O. • IP-4-8WKS(9DAYS TO 40 YRS) • CF-EXCITING EYE -SYMPATHETIC EYE
- 54. ETIOLOGY • INFECTIVE: VIRAL INFECTION • HYPERSENSTIVITY TO UVEAL PIGMENT- Ag-Ab Rxn • VIRAL INFECTION MODIFY UVEAL PIGMENT TO BECOME ANTIGENIC
- 55. SYMPATHISING EYE • PLASTIC IRIDOCYCLITIS • NEURO RETINITIS • CHOROIDITIS • PRODROMAL S/S – SENSITIVITY TO LIGHT – INDISTINCT NEAR OBJECTS – LACRIMATION,TENDERNESS – CILIARY CONGESTION,KP – VITREOUS OPACITIES – ODEMA OF OPTIC DISC
- 56. • FULLY DEVELOPED S.O. – ALL S/S OF PLASTIC OR SEROUS IRIDOCYCLITIS – COURSE : MAY RUN FOR 2-3 YRS • M/E – -EARLY STAGE-NODULAR AGGREGATION OF LYMPHOCYTES & PLASMA CELLS IN UVEA – DALEN FUCH’S NODULES-PIG.EPI. OF IRIS & CB PROL.—NODULAR AGG. +LYMPHOCYTES & EPI. CELLS. LATER ON GIANT CELLS(NO CASEATION) D/D –TB
- 57. EXCITING EYE • IRIDOCYCLITIS(PLASTIC) – LACRIMATION – CILIARY TENDERNESS – CILIARY INJECTION – KP • QUIESCENT STAGE—SHRUNKEN GLOBE • ON S.O.IN SOUND EYE RETURN OF ABOVE S/S IN EXCITING EYE
- 58. TREATMENT • PROPHYLACTIC TREATMENT – ENUCLEATION OF INJURED EYE IF NO REGAIN OF USEFUL VISION LIKELY • EXPECTANT TREATMENT – M/E SURGERY.ENTANGLEMENT OF IRIS,CB,LENS CAP RELEIVED & REPAIR DONE – Rx OF AC. IRIDOCYCLITIS-STEROIDS & MYDRIATICS – IF EYE STILL IRRITABLE- ENUCLEATION(WITHIN 9 DAYS)
- 59. • Rx OF SO – IF JUST DEV.& EXCITING EYE HAS NO USEFUL VISION—IMMEDIATE ENUCLEATION OF EXCITING EYE – Rx OF SYMPATHISING EYE AS OF IRIDOCYCLITIS -ORAL STEROIDS-2mg /Kg Wt PREDNISOLONE -S/TENON DEPOT STEROIDS -TOPICAL STEROIDS x MANY MONTHS