課件說明講稿ocular trauma

1、Ocular TraumaZhuping XuLearning objectivesTo be able to: Take a history in a case of eye trauma.To understand: The effects of trauma on the eye and related structures. The management of penetrating eye trauma. The management of chemical injury to the eye.Ocular TraumaThe damage of ocular structure a

2、nd function due to mechanical、physical and chemical factorsHistory, symptoms and signsA careful history is essential.symptoms will relate to the degree and type of trauma suffered.Sign: VA, Slit lampInitial assessment orderDetermination of the nature and extent of any life threatening problems.Histo

3、ry of the injury, including the circumstances, timing and likely object.Thorough examination of the eyes and the orbits.Rules to deal with ocular trauma Medical and neurological stability should be ensured Chemical injuries require immediate attention and should be treated with copious irrigation pr

4、ior to obtaining a detailed history or performing a full examination. Acute retrobulbar hemorrhage should also be promptly managed with medications to lower the IOP and with a canthotomy with cantholysis to prevent permanent loss of vision. Open globe injuries also require special attention and care

5、.Mechanical ocular traumaExtra-ocular foreign bodiesBlunt traumaPenetrating injuriesWith retained IOFBSympathetic ophthalmitisClassificationNon-mechanical trauma Thermal Injuries Chemical Injuries Radiational Injuries Electrical InjuriesMechanical InjuriesClosed globe Injuries Open globe Injueriesco

6、ntusionrupture lamellar lacerationPenetratingRetained IOFBPerforatinglacerationBlunt traumaConjunctivaCornea contusionCornea abrationTraumatic IridocyclitisClinical manifestation circumcornea congestion， myosis，aqueous flare，KPtreatment 1 atropine drops topical or systemic steroid Traumatic Mydriasi

7、s It is usually permanent and associated with traumatic cycloplegiaIris injuriesIridodialysisPartial dialysis：D-shape pupilBiconvex area seen in peripheral Total dialysis： no irisBlunt traumaIridodialysistraumatic mydriasisdue to damage of iris and ciliary blood vesselsComplications: secondary a, bl

8、ood staining of corneaTraumatic hypheamaTraumatic hypheamaBlood staining of corneabinocular tie up，good rest hemostatic and steroid systemically control IOP by medicine let pupil be surgery Treatment Dislocation of the lens due to complete rupture of the zonulesAnterior, into the anterior chamber or

9、 incarcerated into the pupil, cause secondary a, or endothelium damageDislocation of lens subluxation dislocted to subconjunctiva posterior to the vitreous bodyDeeper anterior chamberiridodonesisAphakia in pupillary area Cause secondary a, retinal detachment or uveitis subluxation of the lens due to

10、 partial tear of zonulesslightly displaced, but still present in the pupillary area dislocated in the anterior chamber or pupil-urgent surgery to remove it into vitreous body-surgery to remove ittreatmentVitreous hemorrhageCaused from ciliary, choroid or retinal vesselsPresence of blood in the vitre

11、ous cavity, fundus is unclearB-scan is helpful Treatmentconservative Vitrectomy 1 months laterVitrectomy once there is retinal detachmentBlunt traumaMacular holeCommotio retinaeChoroidal ruptureBlunt traumaRetinal breaks and detachmentTraumatic optic neuropathyRupture Rupture place limbus hiding scl

12、eral rupture prolapse of uveal tissue, vitreousGLOBE RUPTUREVisual acuity：LP, or no LPEyewall tear、prolapse of contentSubconjunctival hemorrhageCorneal distorsionHypheama, vitreous hemorrhageFundus cant be seenLimited eye movementorbital floor blow-out fracturetreatment repair should be done as soon

13、 as possible a badly damaged globe should be nucleated2. Lacerationfull-thickness wound of eyewall caused by a sharp object.The wound occurs at the impact site by a out-inside mechanismPenetrating injury sharp object or high speed object penetrating eyewall directly small wound： cure by itself large

14、 wound： shallow anterior chamber iris prolapse wound of iris： wound of the lens:Wounds of corneaWound of cornea Flu staining hemorrhage damage of choroid and retina vitreous hemorrhageWound of scleraSuturing the woundPreventing infection and complicationsTreatment Superficial foreign bodyIntraocular

15、 foreign bodiesElectrolytic dissociationions combine with proteinDegeneration changessiderosischalcosisKayser-Fleischer ring golden-brown ring due to copper deposition under peripheral parts of Descmets membrane of corneaSun-flower cataractretinaHarms of IOFBPathogenic microorganisms, intra-ocular i

16、nfectionPenetrating the eyeball History of traumaSymptoms and signs diagnosis X-ray，b-scan，CT, MRIRemove the IOFB as soon as possible anterior chamber and iris IOFB limbus incision，electromagnetism lens IOFB ECCE+remove of the IOFB vitreous cavity or eyewall vitrectomyTreatment acid burnsacid coagul

17、ation of pro. barrier prevent deeper penetrationAlkali burns alkali dissociate fatty and protein increased deep penetration Chemical injuries Three stagesAcute ischaemic necrosisReparationcomplications complicationsTreatmentEmergency treatmentCopious irrigation-BBS, NS, or tap water irrigate the eye fo