blunt trauma of eye , 3rd year mbbs, ophthalmology

1. BLUNT TRAUMA
OF EYE
K.L.VARUN KUMAR
6th term
MVJMC&RH

2. INTRODUCTION
 Eyes are well protected by the lids,projected
margins of the orbit, the nose and a cushion
of fat from behind
 But eyes can be injured in a variety of ways
 Ocular trauma is one of the most under-
recognised causes of vision loss in the
developed world
 Ocular injuries can be a serious threat to
vision if not treated appropriately and in a
timely fashion

3. TYPES
 Mechanical injuries
 Superficial foreign bodies
 Blunt trauma
 Open globe injuries
 Sympathetic opthalmitis
 Chemical injuries
 Alkali burns
 Acid burns
 Thermal injuries
 Electrical injuries
 Radiational injuries : UV , IR , Ionising

4. CAUSES AND PATHOGENESIS OF
DAMAGE IN BLUNT TRAUMA
Blunt trauma may occur following:
 Direct blow, to the eyeball by fist or a tennis or
cricket or another ball or blunt instruments like
sticks, and big stones.
 Accidental blunt trauma ,to eyeball may also occur
in roadside accidents, automobile accidents,
injuries by agricultural and industrial
instruments/machines and fall upon the
projecting blunt objects.

5. MECHANICS OF FORCES OF
BLUNT TRAUMA
 Blunt trauma of eyeball produces damage by
different forces as described below :
1. Direct impact on the globe
2. Compression wave force
3. Reflected compression wave force
4. Rebound compression wave force
5. Indirect force

6. MECHANISMS OF DAMAGE
 The different forces of blunt trauma cause damage to the structures
of thr globe by one or more of following modes :
1. Mechanical tearing of tissues of eyeball
2. Damage to the tissue cells sufficient to cause disruption
of their physiological activity
3. Vascular damage leading to ischemia, oedema and
haemorrhages
4. Trophic changes due to disturbances of the nerve
supply
5. Delayed complications of blunt trauma such as
secondary glaucoma, haemophthalmia, late rosette
cataract and retinal detachment .

7. TRAUMATIC LESIONS OF
BLUNT TRAUMA
 Closed-globe injury
 Globe rupture
 Extraocular lesions

8. 1.CLOSED-GLOBE INJURY
Contusional injuries may vary from a simple corneal
abrasion to an extensive intraocular damage.lesions seen in
this type of injury are :
 CORNEA
 Simple abrasions: These are very painful and diagnosed
by fluorescein staining.These heal within 24hrs with pad
and bandage applied after instilling antibiotic ointment.
 Recurrent corneal erosions(recurrent keractalgia) :
Caused by fingernail trauma. Patient presents with
recurrent attacks of acute pain and lacrimation on
opening eye in the morning and is due to abnormally
loose attachment of epithelium to bowmans membrane.
 Partial corneal tears(lamellar corneal laceration)
 Tears in Descemet’s membrane usually occur in birth
trauma.

9.  Acute corneal oedema : may occur following traumatic
dysfunction of endothileal cells.It may rarely cause
corneal opacity.
 Blood staining of cornea : from associated hyphaema and
raised iop .Cornea is reddish brown or greenish in color
and in later stages lead to dislocation of lens into anterior
chamber.It clears very slowly from periphery towards the
centre and may take upto 2 yrs.

10.  SCLERA
Partial thickness scleral wounds (lamellar scleral
lacerations) may occur.
 ANTERIOR CHAMBER
 Traumatic hyphaema : or blood in anterior chamber
which occurs due to injury to iris or anterior ciliary
vessels.
There are two types of treatments:
1. Conservative 2. Surgical
 Exudates : these collect here following traumatic
uveitis.

11.  IRIS,PUPIL AND CILIARY BODY
 Traumatic miosis :occurs initially due to spasm of
ciliary nerves or with spasm of accomodation.
 Traumatic mydriasis(iridoplegia):It is permanent and
is associated with traumatic cycloplegia.
 Rupture of the pupillary margin
 Radiating tears in the iris stroma
 Iridodialysis: detachment of iris from its root at
ciliary body which results in ‘D’ shaped pupil and a
black biconvex area seen at the periphery.

12.  Antiflexion of the iris : refers to rotation of detached
portion of iris in which its posterior portion faces
anteriorly.It occurs following extensive iridodialysis.
 Retroflexion of the iris :occurs when whole of iris is
doubled back into ciliary region and becomes invisible.
 Traumatic aniridia : the completely torn iris sinks to the
bottom of anterior chamber in the form of a small ball.
 Angle recession : refers to tear between the longitudinal
and circular muscle fibres of ciliary body,characterised by
deepening of ant chamber and widening of ciliary body on
gonioscopy and leads to glaucoma.
 Inflammatory changes : these include traumatic
iridocyclitis, post traumatic iris atrophy etc.
 TREATMENT-consist of atropine,antibiotics and steroids.

13.  LENS
 Vossius ring :It is a circular ring of brown pigment seen on the
anterior capsule.It occurs due to striking of contracted
pupillary margin against the lens.
 Concussion cataract :due to imbibition of aqueous and due to
direct mechanical effects of the injury on lens fibres and may
take any of the following shapes
1. Discrete subepithelial opacities
2. Early rosette cataract
3. Late rosette cataract
4. Traumatic zonular cataract
5. Diffuse concussion cataract
6. Early maturation of senile cataract

14.  Traumatic absorption of the lens:it can occur in children
leading to aphakia.
 Subluxation of lens:due to partial tear of zonules and
there is displacement of lens but is present in the
pupillary area-it can be lateral or vertical.
 Dislocation of lens:when rupture of zonules is complete
and can be intraocular or extraocular.
 INTRAOCULAR:into anterior chamber or posterior
vitreous
 EXTRAOCULAR:subconjunctival space or may fall
outside the eye

15.  VITREOUS
 Liquefaction and appearance of clouds of fine
pigmentary opacities
 Detachment of the vitreous either anteriorly at
the base or posterior (PVD) may occur
 Vitreous haemorrhage
 Vitreous herniation in the anterior chamber
may occur with subluxation or dislocation of
the lens.

16.  CHOROID
 Rupture of choroid : is concentric to optic disc and
situated temporal to it and can be single or multiple.On
fundus examination it looks like whitish crescent with
fine pigmentation at its margins.Retinal vessels pass
over it.
 Choroidal haemorrhage may occur under retina or may
even enter the vitreous if retina is torn.
 Choroidal detachment
 Traumatic choroiditis : seen on fundus examination as
patches of pigmentation and discoloration after eye
becomes silent.

17.  RETINA
 Commotio retinae(Berlin’s oedema):common occurences
following a blow on the eye.It manifests as milky white
cloudiness involving a considerable area of posterior pole
with a cherryred spot in the foveal region.It may
disappear after some days or may be followed by
pigmentary changes.
 Retinal haemorrhages:eg:flame shaped and preretinal D
shaped haemorrhage may be associated with traumatic
retinopathy.
 Retinal tears:these follow a contusion in eyes suffering
from myopia or senile degenerations.

18.  Traumatic proliferative retinopathy :occur secondary to
vitreous haemorrhage.
 Retinal detachment : follows retinal tears or vitreo-retinal
tractional bands.
 Concussion changes at macula : traumatic macular
oedema followed by pigmentary degeneration.
Sometimes, a macular cyst is formed,which on
rupture is converted to a lamellar or full thickness
macular hole.

19.  IOP CHANGES IN CLOSED-GLOBE
INJURY
 Traumatic glaucoma
 Traumatic hypotony: it may follow damage to the ciliary
body and may result in phthisis bulbi.
 TRAUMATIC CHANGES IN
REFRACTION
 Myopia may follow ciliary spasm or rupture of
zonules or anterior shift of lens
 Hypermetropia and loss of accomodation may result
from damage to the ciliary body.

20. 2.GLOBE RUPTURE
 It is a full-thicknesswound of eye-wall caused by blunt object
and can occur in 2 ways:
 Direct rupture : at the site of injury.
 Indirect rupture :occurs because of compression force.The
impact results in momentary increase in IOP and inside
out injury at the weakest part of the eyewall,i.e in the
vicinity of canal of schlemm concentric to the limbus.The
superonasal limbus is the most common site.
 TREATMENT: A badly damaged globe should be
enucleated.In less severe cases it can be repaired under
general anaesthesia.

21. 3.EXTRAOCULAR LESIONS
 Conjuctival lesions : subconjunctival haemorrhages
are seen as bright red spot.
 Eyelid lesions : Ecchymosis of eyelids.Because of loose
subcutaneous tissue,blood collects easily into the lids
and produces BLACK-EYE.Traumatic ptosis may
follow damage to leavtor muscle. Laceration and
avulsion of lids can occur.
 Optic nerve injuries : associated with fracture of base
of skull.
 Orbital injury :there may occur fracture of orbital
walls. Orbital haemorrhage may produce sudden
proptosis. Orbital emphysema may occur following
ethmoidal sinus rupture.

23. THANK YOU!