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Sam Alexander, MD
Ocular Trauma &
Emergencies
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1.3 million eye injuries per year in the United States
40,000 of these injuries lead to visual loss
Eye Trauma: Incidence
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Are one or both eyes affected?Vision at time of examination?Vision prior to trauma?
The History: Vision
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Symptoms besides decreased vision?Duration of symptoms?Any surgery prior to trauma?
The History: Symptoms
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Are one or both eyes affected?Vision at time of examination?Vision prior to trauma?
The History: Vision
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Complete Eye ExaminationVision
External exam
Pupils
Motility exam
Anterior segment
Ophthalmoscopy
Pressure
Visual fields
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A true ocular emergencyAlkali more serious than acidImmediate irrigation essential
Chemical Burns
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Irrigation of chemical burns should be initiated before arrival
at emergency center.
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Topical anesthesiaCopious irrigationCheck for foreign bodies
Chemical Burns: Initial EC Management
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Topical cycloplegicTopical antibioticPatch eyePrompt referral to ophthalmologist
Chemical Burns: EC Treatment Following Irrigation
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Assume globe is rupturedShield eye and refer to ophthalmologist25% of patients have other ocular injuries
Management of Hyphema
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Surgery indicated only for persistent diplopia or poor cosmesis
Surgery can be delayed since diplopia may be transient
Orbital Trauma: Isolated Blow-Out Fractures
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Avoid lid margin retractionGive tetanus prophylaxisRemove superficial foreign bodiesRule out deeper foreign bodies
Superficial Lid Lacerations
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Foreign body sensationPainTearingPhotophobia
Corneal Abrasions: Symptoms
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Topical cycloplegicTopical antibiotic
Corneal Abrasions: Treatment
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Thank You!
Questions?