Ocular Traumatic Damages

1. THEMETHEME:: OCULAROCULAR
TRAUMATIC DAMAGESTRAUMATIC DAMAGES..

2. Classification of traumatic damageClassification of traumatic damage
I. By etiologyI. By etiology::
1) Industrial1) Industrial
2) Agricultural2) Agricultural
3) Domestic3) Domestic
4) Children's4) Children's
5)5) SportiveSportive
II. By traumatic agentII. By traumatic agent
1) Mechanical1) Mechanical
2) Thermal2) Thermal
3) Chemical3) Chemical
4) Radiation4) Radiation
ІІІ.ІІІ. By mechanism of traumaBy mechanism of trauma::
1) Burns1) Burns
2)2) Blunt trauma (contusion)Blunt trauma (contusion)
3)3) InjuriesInjuries
IV. By localization:IV. By localization:
А)А) AdnexaAdnexa ((orbitorbit,, eyelidseyelids,, lacrimal organslacrimal organs,, oculomotoroculomotor
musclesmuscles))
Б)Б) Eye globeEye globe
-- non-penetrating;non-penetrating;
- penetrating- penetrating

3. EpidemiologyEpidemiology
 The surface of the eye occupiesThe surface of the eye occupies 0,15%0,15% of all body surfaceof all body surface,,
however ocular trauma takes place inhowever ocular trauma takes place in 5-10%5-10% at time of peace andat time of peace and
inin 2%2% during the war in all amount of injuriesduring the war in all amount of injuries
 Eye trauma occurs in more thanEye trauma occurs in more than 10%10% of all ocular diseases.of all ocular diseases. TheThe
majority of eye injuriesmajority of eye injuries ((up toup to 90%) –90%) – microtrauma andmicrotrauma and
contusionscontusions.. Penetrating injuries take no more thanPenetrating injuries take no more than 2%,2%, burns takeburns take
aboutabout 8%8% of all casesof all cases..
 86,5%86,5% cases of eye injuries are industrialcases of eye injuries are industrial,, inin 65%65% cases eyecases eye
trauma occurs because of labor safety standards violationstrauma occurs because of labor safety standards violations ..
 Among peopleAmong people,, obtaining severe ocular traumaobtaining severe ocular trauma , 89,9%, 89,9% are menare men,,
andand 10,10,11%% are womenare women.. Traumas occur more often in youngerTraumas occur more often in younger
peoplepeople.. The age ofThe age of 60%60% of the traumatized patients is underof the traumatized patients is under 40.40.
AboutAbout 22%22% of the hospitalized patients with trauma are childrenof the hospitalized patients with trauma are children
underunder 16.16.

4. Results of treatment
1,0
0,5-0,9
0,04-0,4
0,00-0,03
энуклеация
глаза

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6. ContusionsContusions
І.І. OrbitalOrbital,, extraocular musclesextraocular muscles
А.А. Orbital wall fracturesOrbital wall fractures
-- subcutaneous emphysemasubcutaneous emphysema
-- proptosis (exophthalmos)proptosis (exophthalmos)
-- enophthalmosenophthalmos
-- connection with cranial cavitiesconnection with cranial cavities
В.В. Superior orbital fissure syndrome:Superior orbital fissure syndrome:
nn. Т. Тrochlearisrochlearis -- ptosisptosis
nn. О. Оculomotoriusculomotorius -- proptosisproptosis
nn.. AbducensAbducens -- ophthalmoplegiaophthalmoplegia
nn. О. Оphtalmicusphtalmicus -- decrease of corneal sensitivitydecrease of corneal sensitivity
v.v. ОрОрhtalmicahtalmica -- midriasismidriasis
superiorsuperior -- accommodative palsyaccommodative palsy
-- retinal hemorrhagesretinal hemorrhages
С. СаС. Саnalisnalis орорticusticus
- optic nerve evultion- optic nerve evultion::
- evultion before- evultion before 1414 mmmm from the eyeglobefrom the eyeglobe →→ clinics of centralclinics of central
retinal artery occlusionretinal artery occlusion
- evultion behind- evultion behind 1414 mmmm →→ in two weeks clinics of primary opticin two weeks clinics of primary optic
nerve atrophynerve atrophy

7. Subcutaneous emphysemaSubcutaneous emphysema

8. Orbital floor fractureOrbital floor fracture

9. Optic nerve evulsionOptic nerve evulsion

10. DD.. Pulsative exophthalmosPulsative exophthalmos ((internal carotid arteryinternal carotid artery
inside the cavernous sinusinside the cavernous sinus))
EE.. Trochlea fractureTrochlea fracture →→ diplopiadiplopia
F. OphthalmoplegiaF. Ophthalmoplegia
2.2. EyelidsEyelids,, lacrimal organslacrimal organs
А.А. PtosisPtosis
В.В. Eyelids hematomaEyelids hematoma
С.С. Symptom ofSymptom of ““glassesglasses" (" (scull base fracturescull base fracture))
DD.. Eyelids ruptureEyelids rupture
- Parallel to the lids margin- Parallel to the lids margin →→ tiny scarstiny scars
- Perpendicular to the lids margin- Perpendicular to the lids margin →→ thick scarsthick scars→→
→→ ectropionectropion,, eyelid colobomaeyelid coloboma
- Middle 1/3 of the upper eyelidMiddle 1/3 of the upper eyelid →→ ptosisptosis
EE.. Lacrimal canaliculi ruptureLacrimal canaliculi rupture→→ constant tearingconstant tearing

11. Penetrating orbitalPenetrating orbital injuries with foreigninjuries with foreign
bodiesbodies

12. Penetrating orbitalPenetrating orbital injuries with foreigninjuries with foreign
bodiesbodies

13. Lower eyelid penetrating injury (rupture)Lower eyelid penetrating injury (rupture)
 First aidFirst aid:: wash withwash with
antisepticantiseptic;;
 Put sterile bandagePut sterile bandage;;
 Inject antitetanus serumInject antitetanus serum;;
 Principles of surgicalPrinciples of surgical
treatmenttreatment::
1)1) Restoration of tear canaliculiRestoration of tear canaliculi
patencypatency;;
2)2) Suturing of intermarginalSuturing of intermarginal
edgeedge;;
33) Layer-by-layer suturing) Layer-by-layer suturing––
tarso-conjunctive layer istarso-conjunctive layer is
sutured with absorbablesutured with absorbable
suturessutures,, muscular-cutaneousmuscular-cutaneous
layerlayer –– thin non-absorbablethin non-absorbable
sutures.sutures.

14. Subconjunctive hemorrhageSubconjunctive hemorrhage
 TreatmentTreatment::
dissolving therapydissolving therapy––
KIKI 1-2%,1-2%, enzymesenzymes
((wydasewydase,,
fibrinolysinumfibrinolysinum))

15. HyphemaHyphema –– anterior chamber hemorrhageanterior chamber hemorrhage
 First aidFirst aid:: bilateral patchingbilateral patching
and strict bed restand strict bed rest,, coldcold
compress to eye areacompress to eye area (2 - 3(2 - 3
hourshours),), intramuscularintramuscular
injections of angioprotectorsinjections of angioprotectors..
Corticosteroids for decrease ofCorticosteroids for decrease of
inflammation signs, control ofinflammation signs, control of
intraocular pressureintraocular pressure

16. Iris blunt traumaIris blunt trauma
 Traumatic miosisTraumatic miosis
 Traumatic midriasisTraumatic midriasis
 Pupillary rupturePupillary rupture
 IridodialysisIridodialysis –– irisiris
root ruptureroot rupture
 CyclodialysisCyclodialysis ––
ciliary body ruptureciliary body rupture

17. Lens dislocationLens dislocation
 To the anteriorTo the anterior
chamberchamber
 To the vitreous bodyTo the vitreous body
 Under the conjunctivaUnder the conjunctiva
 Lens subluxationLens subluxation

18. Blunt trauma of choroid and retinaBlunt trauma of choroid and retina
 HemophthalmosHemophthalmos –– vitreousvitreous
hemorrhagehemorrhage;;
 HemorrhagesHemorrhages::
- preretinalpreretinal
- retinalretinal
- subretinalsubretinal
 PosttraumaticPosttraumatic commotioncommotion
of retinaof retina–– Berlin’s edemaBerlin’s edema

19. Blunt trauma of choroid and retinaBlunt trauma of choroid and retina
 Retinal tearRetinal tear
 Retinal ruptureRetinal rupture
 Retinal detachmentRetinal detachment

20. Eyeglobe injuriesEyeglobe injuries
I. Non-penetratingI. Non-penetrating
II. PenetratingII. Penetrating
By entrance siteBy entrance site
1)1) cornealcorneal
- hypotony- hypotony
- IOH leakage from the anterior chamber- IOH leakage from the anterior chamber
- shallow anterior chamber- shallow anterior chamber
- iris prolaps- iris prolaps
2)2) scleralscleral
- hypotony- hypotony
- deep anterior chamber- deep anterior chamber
- prolaps of inner covers or vitreous body- prolaps of inner covers or vitreous body
- hemophthalmos (vitreous hemorrhage)- hemophthalmos (vitreous hemorrhage)
3)3) Corneo-scleralCorneo-scleral
III.III. Perforating throughPerforating through
- entrance and exit sites- entrance and exit sites
IV.IV. Eyeglobe crushEyeglobe crush

21. Eyeglobe injuriesEyeglobe injuries
 Simple (non-complicated)Simple (non-complicated)
 Complicated:Complicated:
1)1) With intraocular foreign bodyWith intraocular foreign body
aa)) examinationexamination →→ X-ray with prosthesis-localizerX-ray with prosthesis-localizer
by Komberg-Baltin in 2 projectionsby Komberg-Baltin in 2 projections;; computedcomputed
tomography (CT) scanningtomography (CT) scanning →→ foreign bodyforeign body
localizationlocalization
bb)) absolute (reliable) signsabsolute (reliable) signs
-- entrance siteentrance site
-- hole in the irishole in the iris
-- internal covers prolapsinternal covers prolaps
-- punctatepunctate penetrating lens opacificationpenetrating lens opacification
-- intraocular foreign bodyintraocular foreign body
cc)) methods of foreign bodies removalmethods of foreign bodies removal
-- trans-scleraltrans-scleral
-- directdirect –– through the entrance sitethrough the entrance site
-- anterioranterior –– through the paracentesisthrough the paracentesis

22. 2)2) endophthalmitisendophthalmitis=►=►eyeglobe enucleationeyeglobe enucleation
(removal)(removal)
3)3) panophthalmitispanophthalmitis=►=►eyeglobe eviscerationeyeglobe evisceration
4)4) Sympathetic ophthalmiaSympathetic ophthalmia
-- serous iridocyclitisserous iridocyclitis
-- fibrinous iridocyclitisfibrinous iridocyclitis
-- neuroretinitisneuroretinitis::
**depression of fisual fiels to the blue colordepression of fisual fiels to the blue color
**extension ofextension of punctum proximumpunctum proximum

23. Corneal erosionCorneal erosion
 DiagnosticsDiagnostics: 1%: 1% sol.sol.
fluoresceinefluoresceine
 TreatmentTreatment:: oftenoften
installations ofinstallations of
antiseptics, epithelializingantiseptics, epithelializing
eyedrops and ointmentseyedrops and ointments;;
sterilesterile monocularmonocular
bandagebandage

24. Foreign body of conjunctiva and corneaForeign body of conjunctiva and cornea
 First aidFirst aid::
 Install anesthetic solutionInstall anesthetic solution
 Remove foreign body with wet cottonRemove foreign body with wet cotton
plug or forsepsplug or forseps
 Corneal foreign body must be removedCorneal foreign body must be removed
only under the microscope control byonly under the microscope control by
ophthalmologistophthalmologist!!
 Install antiseptic solutionInstall antiseptic solution
 Monocular bandageMonocular bandage

25. Perforating corneal injury accompaniedPerforating corneal injury accompanied
by traumatic cataractby traumatic cataract

26. Penetrating corneal injuriesPenetrating corneal injuries

27. Penetrating scleral and corneoscleral injuriesPenetrating scleral and corneoscleral injuries
First aidFirst aid::
 Wide-spectrumWide-spectrum
antibiotic in eyedropsantibiotic in eyedrops
and systemicallyand systemically;;
 AnalgeticsAnalgetics;;
 Tetanus prophylaxisTetanus prophylaxis
 Binocular bandageBinocular bandage;;
 Transporting to theTransporting to the
eye traumaeye trauma
department in supinedepartment in supine
positionposition..

28. Perforating injury with iris prolapsPerforating injury with iris prolaps

29. Eyeglobe crushEyeglobe crush
 Primary surgical treatmentPrimary surgical treatment::
 Washing of conjunctiva withWashing of conjunctiva with
antibioticsantibiotics;;
 Setting in of prolapsedSetting in of prolapsed
structures, at inability or theirstructures, at inability or their
necrosis perform of removal ofnecrosis perform of removal of
prolapsed inner structuresprolapsed inner structures;;
 Suturing of the ruptured fibrousSuturing of the ruptured fibrous
capsule edgescapsule edges;;
 At inability of eye restorationAt inability of eye restoration
perform enucleation (removal)perform enucleation (removal)
of the eyeof the eye

30. Foreign body in the anterior chamberForeign body in the anterior chamber

31. Foreign body in the corneaForeign body in the cornea

32. Foreign body in the lensForeign body in the lens

33. Foreign body on the retinaForeign body on the retina

34. Foreign body wedged into the optic nerveForeign body wedged into the optic nerve

35. Penetrating injury with hypopionPenetrating injury with hypopion

36. Diagnostics of intraocular foreign bodiesDiagnostics of intraocular foreign bodies
 X-rayX-ray
 X-ray by Komberg-BaltinX-ray by Komberg-Baltin
with prostesis-localizerwith prostesis-localizer
 X-ray by FogtX-ray by Fogt
 Computed tomographyComputed tomography
 MRI is prohibitedMRI is prohibited!!

37. X-ray examination by Komberg-BaltinX-ray examination by Komberg-Baltin

38. Computed tomographyComputed tomography

39. Zeidel testZeidel test

40. Chemical burnsChemical burns
 ClassificationClassification:: acid and alkaliacid and alkali --
ammonium chlorideammonium chloride,, burnt limeburnt lime,,
silicate gluesilicate glue,, aniline dyes areaniline dyes are
alkali, care must be taken atalkali, care must be taken at workwork
with themwith them!!
 By severityBy severity:: I, II, III, IV gradeI, II, III, IV grade
 First aidFirst aid::
 Install anestheticsInstall anesthetics
 Wash with big amount of waterWash with big amount of water
 Remove small particle of limeRemove small particle of lime
 Install antibiotics of wide spectrumInstall antibiotics of wide spectrum
 Tetanus prophylaxisTetanus prophylaxis
 No bandagesNo bandages!!

41. Chemical burn of IV gradeChemical burn of IV grade
 ComplicationsComplications::
 Corneal meltingCorneal melting
 CornealCorneal
opacificationopacification
 SymblepharonSymblepharon
 Burn iridocyclitisBurn iridocyclitis
 SecondarySecondary
glaucomaglaucoma
 ComplicatedComplicated
cataractcataract

42. Corneal erosion with growingCorneal erosion with growing
pannuspannus

43. Perforation of the corneaPerforation of the cornea

44. Radiation burnsRadiation burns –– solarsolar,, x-ray radiationx-ray radiation,, laserlaser
equipmentequipment,, ultraviolet radiationultraviolet radiation

46. Thank youThank you
for yourfor your
attention!attention!