eye traumatology mudr. břetislav brožek, csc

Eye Traumatology

MUDr. Břetislav Brožek, CSc.

www.brozek.cz

•

Structure of lecture

•In accordance mechanism and type of

injury

•In accordance with part of eye orgánu

• most often clinical injury

Mechanism of accident

• In accordance with activity: industrial, trafic, child

• In accordance with nature: mechanical, radiation, heat, chemical, combined

Occupational Injury• perfect record,

relationship worker/employer

• record about protective tools

• protect the pacient and also yourself

Trafic and sports injuries

• mostly significant and combined

• mostly you´ll examine in other department

• watch eye motility problem – brain injury

Child injury

• always serius, watch inproper care of adults

• very often incorrect or untrue anamnestic

data

• often hidden perforative injury

• watch battered children

Specific child´s eye injuries

• Prenatal injury – during amniocenthesis

• obstetric forceps: tears of Desc.membr.

hemoragies on eye fundus

edema and bleeding to lids

• must to notify

Structure due nature

• mechanical: cutting, lacerated, blunt, combined• radiation: UV, sun, IR• heat• chemical

mechanické

• cutting, stub: nives, sticks, scissors, limb, wires,

flying bodies …..• lacerated: larger tools, teeth of animals• contusion: balls, hockey-stick, cornu of animal,

elbows, knees• combined• foreign bodies inside od eye and orbit

•

radiation

• UV : sun, snow blindness, sea, ozone hole

welders.

• sun: do not look to the sun during

eclipse of the sun

• IR záření – sklářská katarakta, hoblinky

• lasers (different danger accord. power)

• ionizing – like snow blindness, cataract

oftalmia fotoelectrica

oftalmia fotoelectrica

• welding, UV rays in mountains• damage of epithelium cells• start of pain 4-6 hours after welding

welder is coming at one hour at night….• atb a epitheliz. Ointm,

heat

• everything, even cigarettes• mostly lids, burned lashes• cornea – boiled egg white• oedema, erythema, pain, blisters, necrosis,

coaling• sterile cover, atb ointm., burns unit,• scarring, lagoftalmus, closed lacrimal ways

•

chemical

• serious: at work, military, industry• home: cleaning chemicals• street: tear gas• LIME white lime, whitewash• wash and wash, eversion of lids• careful medical record,• you see: hyperaemia, oedéma of conj., abrasion of cornea white stroma, iritis.therapy: atb ointm., mydriatics, artef.tears, steroids only eye doc., , transplantation of cornea

ischemia of limbus and conjunctiva

cloudy cornea

strong cloudy cornea

complete opaque cornea

poškození okolí oka a předního segmentu oka slzným plynem

poleptání oka a jeho okolí alkálií

perforovaný vřed rohovkyzalepený cyanoakrylátovým lepidlem

povrchní vazkularizace rohovky po poleptání

Injury of conj. and cornea:

• conj. abrasion - pain, ointm.• corneal abrasion: strong pain, atb ointm.,

carefull controls, pressure dressing,

recidiv.abrasion, Cont.lens, • forign bodies: under the lids, in a cornea• must be extracted, strong pain, controls • atb ointm., possible iritis

•

corneal foriegn body

eroze rohovky – etiologie nejrůznější

•

•

•

•

glue

•

flyblow

flyblow

perforating injury of sclera

• often with cornea• always with coinjuntiva• always injury of retina• often with foriegn body• always very serious, • always urgent surgery•

perforating injury

• always serious• gravity of consequences accord. deepness of

injury• foriegn body• with prolaps of tissue or without• blunt injury = rupture of globe

peaked pupil

řezná rány skléry s prolapsem sklivce

řezná rány skléry s prolapsem iris

extrémní ruptura bulbu

lehčí ruptura bulbu

řezná rána rohovky a čočky

immediate treatment and surgery

• specialised hospital and eye clinic• watch hidden ruptures and perforations• risk of sympathetic ophthalmy

intraocular foriegn body

• metallic x nonmetallic (CT?, NMR)• magnetic x nonmagnetic• ant. segment x posterior segment• very urgent, admition, surgery• only specialized clinics

preretinální nitrooční kovové těleso s preretinální hemoragií

nitrooční těleso v komorovém úhlu

•

eye contusion

• often serious,• damage of many tissues:• cornea: abrasion, edéma• ant.ch: hyphema• iris: iridorexis (tear of margin), iridodialysis

(break of root)• dislocation of lens and cataract• contusion of retina, breaks of retina and choroid• total rupture of globe

•

iridodirhexis – trhliny zornicového okraje

iridodialysis

•

traumatic dislocation of lens temporally down in posterior chamber

luxation of lens into the anterioe chamber after blunt trauma

central retina hole after trauma

avulsion of optic nerve

čerstvá ruptura sítníce

stará ruptura sítnice

blow-out fracture

• direct stroke to eye – spreading of pressure in orbit• fracture of wall of orbit, mainly floor• incarceration a prolaps of tissue to fracture• enoftalmus, vertic. motility problem• diplopie, mainly vertical

•

Always pefect medical records !

• you must guard youself• lawyers do not sleep•

Never forget !

• irrigation of lacrimal ways as soon as possible• it is not so simple

• no squint is normal – NEVER !• remember possible intraocular tumor • immediate eye examination

• lazy eye blindness you cannot educate

after 4-5 years

Thank You for you attention

The best students can became eye microsurgeons