TMA Department of eye diseases Ocular traumas Types

TMA Department of eye diseases Ocular traumas

Types of Eye Injury n n n There a great variety of possible eye injuries but they tend to fit into the following basic types. Blunt ocular traumas Penetrating ocular traumas Non-penetrating ocular traumas Chemical eye injuries Minor superficial eye injuries: corneal abrasions corneal and conjunctival foreign bodies conjunctival lacerations Eyelid injuries Orbital injuries and fractures Burns of cornea, conjunctiva and eyelid

Distribution n Burns Penetrating eye injuries Non-penetrating eye injuries 2 10 6 % 80 Blunt injuries

Blunt trauma of soft tissues and orbit Injuries are divided by localization: n Blunt traumas of soft tissue and orbit n Closed fractures of orbit

Blunt traumas of soft orbital tissues Signs: - Subconjunctival haemorrage - Haematoma of eyelids - Absence of ocular movements

Orbital fractures signs: - diplopy - enoftalm - absence of ocular movements

Orbital fractures а b 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 c

First-aid tactics n n n 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.

Blunt injuries of eye (contusion) Divided according to severity: Mild - complete recovery n Medium - small residual symptoms do not affect visual function n Severe - there are large morphological and functional disorders n Very severe - Rough morphological changes, loss of function

Blunt injuries of the eye Mechanism of eyeball contusion (schematic view)

Blunt injuries of the eye Signs: n n n Subconjunctival haemorrage Corneal erosion Hyphaema Haemophthalm (vitreous haemorrhage) Iridodonezis (trembling of iris) Mydriazis Subluxation of lens Iridodializis (detachment or tear of the iris) Choroidal or retinal ruptures Retinal detachment Avulsion of an optic nerve

Choroidal or retinal ruptures Oedema of the cornea and hyphema Ruptura of the pupillae

Blunt injuries of the eye n. Iridodializis Dislocation of the lens

Blunt injuries of the eye Choroidal ruptures and partial haemophthalmos

Horoidal or retinal ruptures Traumatic avulsion of optic nerve Retinal detachment

Blunt injuries of the eye Subconjunctival ruptures of eye

First-aid tactics Instillation into the conjunctival sac of antibiotics or sulfa eye drops n Anesthesia (local and general) n Easy aseptic bandage n Immediately send to ophthalmologist n

Injuries of surrounding tissues By localization injuries are divided into: n Injuries of eyelids n Lacrymal ducts injuries n Foreign bodies

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 tactics n n n Tetanus toxoid Washing the wound with disinfectant solutions Parenteral (i/m) administration of antibiotics Easy aseptic bandage Immediately send to ophthalmologist

Wounds of an eyeball n - Divided by localization: Corneal wounds Scleral wounds Corneoscleral wounds By penetrating of external walls Penetrating injury Non-penetrating injury Penetrating injuries are divided into 2: With intraocular foreign body With exit of intraocular tissues from the wound

Wounds of an eyeball Penetrating injury of cornea, absence of anterior chamber Penetrating injury of cornea, anterior chamber is present

Eyeball injuries Penetrating injury of cornea with exit of iris Penetrating corneaal wound complicated with lens opacification

Eyeball wounds Penetrating wound of sclera with exit of iris Corneoscleral penetrating injury with foreign body

Injuries of an eyeball Borders of cornea are adapted, penetrating wound with foreign body in anterior chamber. Penetrating scleral wound with foreign body.

First-aid tactics n n n Tetanus toxoid Washing the wound with disinfectant solutions Parenteral administration of antibiotics Binocular aseptic bandage Immediately send to ophthalmologist

Treatment tactics n - Performed by ophthalmologist in specialized clinics: 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.

Injuries of eyeball Severe complications after penetrating wounds of the eyeball n Endophthalmitis n Panophthalmitis n Sympathetic ophthalmia

Thermic and chemic burns of eyes Burns of eyelids and conjunctiva are divided by severety I (mild) degree - redness and swelling II (average) degree – bubbles III (severe) degree - ischemia and necrotic zone IV (very severe) degree - necrosis

Thermic and chemic burns of eyes Classification by severety: I (mild) degree – hyperemia of eye tissues, oedema, superficial corneal erosion. II (medium) degree – deep corneal erosion, oedema, ishchemisation of conjunctiva and limbus area III (severe) degree – in addition to the above mentioned corneal opacification like misted glass in the necrotic zones IV (very severe) degree – porcelain cornea, total necrosis of conjunctiva, perforation

Thermic and chemic burns of eyes Mudium degree of chemical burn of conjunctives. Ischemic zone of lymbic area Medium degree of chemical burn of corneal layer

Кўз олмаси термик ва кимёвий куйишлари chemical burns, severe lens chemical burns of the eyeball is extremely severe

Кўз олмаси термик ва кимёвий куйишлари chemical burn extremely severe. complications of cataract lens chemical burn extremely severe. edematous cataract, secondary glaucoma

Thermic and chemic burns of eyes Very severe thermic burn

Thermic and chemic burns of eyes Very severe thermic burn of eyeball and surrounding tissues

Thermic and chemic burns of eyes Severe theromochemical burn of. Very severe thermochemical burns, an eyeball. 1 month after the complicated cataract injury.

First-aid tactics n n n 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 eyes n n n the outcome of burns mild to moderate favorable burns of moderate and severe usually leave behind changes require surgery children with complications from burns of moderate and severe group are entered in the prevention of ocular pathologies and for a long time kept under medical observation

Prophylaxis 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.