Ocular InjuryOcular Injury

Department of OphthalmologyDepartment of OphthalmologyTianjin Medial University General HospitalTianjin Medial University General Hospital

Hua Yan, MD, PhDHua Yan, MD, PhDphuayan2000@163.comphuayan2000@163.com

www.apots.orgwww.apots.org

General descriptionGeneral description

• The structure of the visual organThe structure of the visual organ

isis very fine and weakvery fine and weak

• Lose the ability to workLose the ability to work

• Difficulties and sufferings in lifeDifficulties and sufferings in life

• Prompt and right managementPrompt and right management

Classification of ocular injury Classification of ocular injury

• Mechanical ocular injuryMechanical ocular injuryContusion Contusion LacerationLacerationRuptureRupture

• Non-mechanical ocular injury Non-mechanical ocular injury ocular chemical burns ocular chemical burns thermal burnsthermal burnsradiation damageradiation damage

Classification of mechanical ocular injuryClassification of mechanical ocular injury

Lamellar lacerationLamellar laceration

Ocular injuryOcular injury

Closed injuryClosed injury Open injuryOpen injury

ContusionContusion LacerationLaceration RuptureRupture

PenetratingPenetrating IFBIFB PerforationPerforation

Mechanical injury of the eyeMechanical injury of the eye

• Make up more than 80% of the total injuriesMake up more than 80% of the total injuries metal fragment, metal fragment, instruments in work, instruments in work, knife, knife, scissors, scissors, needle, needle, pliers, pliers, shells, shells, ears of wheat and grain, ears of wheat and grain, spots instruments, spots instruments, toys at home,toys at home, explosive flying stone, explosive flying stone, iron piece, iron piece, shell fragment in battlefieldshell fragment in battlefield

Mechanical injury of the eyeMechanical injury of the eye

• Take place Take place young workersyoung workersstudentsstudentsyouth youth people short of experience in work people short of experience in work

Orbital InjuryOrbital Injury

Orbital injury - clinical findingsOrbital injury - clinical findings

• Fracture of orbital wall and nearby cranial bone, Fracture of orbital wall and nearby cranial bone, nasal sinuses and optic canal (leading to optic nenasal sinuses and optic canal (leading to optic nerve atrophy)rve atrophy)

• Fracture of the ethmoid sinus (subcutaneous emFracture of the ethmoid sinus (subcutaneous emphysema)physema)

• Injuries of the eyelids, the globe and deep soft tiInjuries of the eyelids, the globe and deep soft tissue of the orbit (orbital cellulitis)ssue of the orbit (orbital cellulitis)

• Intraorbital hemorrhage may induce exophthalmIntraorbital hemorrhage may induce exophthalmos and palpebral ecchymoma os and palpebral ecchymoma

Orbital injury - treatmentOrbital injury - treatment

• Complications of nervous or systemic system - managementComplications of nervous or systemic system - management• Closed simple fracture of the orbital bony rim - no special trClosed simple fracture of the orbital bony rim - no special tr

eatmenteatment• Severe injury of skull, reflex of the pupil should be examineSevere injury of skull, reflex of the pupil should be examine

dd• Severe injury of soft tissue - debridement and suturing layer,Severe injury of soft tissue - debridement and suturing layer,

TAT and antibiotic TAT and antibiotic• Large foreign body in the orbit should be extracted as early Large foreign body in the orbit should be extracted as early

as possibleas possible• Small and deep ones, generally extractive operation isn’t neSmall and deep ones, generally extractive operation isn’t ne

eded.eded.• Intraobital hemorrhage - pressure bandage Intraobital hemorrhage - pressure bandage

Palpebral injuryPalpebral injury

Palpebral injury - clinical findingsPalpebral injury - clinical findings

• Palpebral skin is thin and loose, it is quite easy to be Palpebral skin is thin and loose, it is quite easy to be healed after injury and the infection is rarehealed after injury and the infection is rare

• Palpebral swelling and hemorrhagePalpebral swelling and hemorrhage

• Subconjunctival hemorrhage may spread into the subSubconjunctival hemorrhage may spread into the subcutaneous tissue of another eye through the nose bridcutaneous tissue of another eye through the nose bridgege

• Breakdown of the palpebral marginBreakdown of the palpebral margin

• Breaking of ligaments of the inner and outer canthiBreaking of ligaments of the inner and outer canthi

Palpebral injury - treatmentPalpebral injury - treatment

• The palpebral edema and hemorrhage may be The palpebral edema and hemorrhage may be absorbed spontaneouslyabsorbed spontaneously

• Fresh wound must be debridement and sutured Fresh wound must be debridement and sutured as early as possibleas early as possible

• Tetanus antitoxin (TAT)Tetanus antitoxin (TAT)

• AntibioticAntibiotic

Conjunctival foreign body - clinical finConjunctival foreign body - clinical findingsdings

• Dust, coal dust and small insectDust, coal dust and small insect• Most of the foreign bodies are pushed into the inferioMost of the foreign bodies are pushed into the inferio

r tarsal sulcus of the upper eyelid r tarsal sulcus of the upper eyelid • Foreign body sensation, pain, tearing, and palpebral sForeign body sensation, pain, tearing, and palpebral s

pasmpasm• Conjunctival hyperemiaConjunctival hyperemia• Eyelid is everted, fine foreign body often lodges in thEyelid is everted, fine foreign body often lodges in th

e lower tarsal sulcus of the conjunctiva in the upper ee lower tarsal sulcus of the conjunctiva in the upper eyelidyelid

Conjunctival foreign body - treatmentConjunctival foreign body - treatment

• Removed by wet cotton roll or clean towelRemoved by wet cotton roll or clean towel

Corneal foreign bodyCorneal foreign body

Corneal foreign body - etiologyCorneal foreign body - etiology

• Metal piecesMetal pieces

• Dust in atmosphereDust in atmosphere

• InsectsInsects

• HusksHusks

• Explosive injuryExplosive injury

Corneal foreign body - clinical Corneal foreign body - clinical findingsfindings

• Foreign body sensationForeign body sensation

• PainPain

• PhotophobiaPhotophobia

• TearingTearing

• Palpebral spasmPalpebral spasm

Corneal foreign body - treatmentCorneal foreign body - treatment

• Don’t rub the eyeDon’t rub the eye

• Remove with cotton-tipped applicator after surRemove with cotton-tipped applicator after surface anesthesia with 0.5%-1% dicaine solutionface anesthesia with 0.5%-1% dicaine solution

• After several hours of existing, an iron pieces After several hours of existing, an iron pieces arouses siderosis on its surrounding tissuearouses siderosis on its surrounding tissue

• Rust is difficult to be removed clearlyRust is difficult to be removed clearly

Penetrating injuryPenetrating injuryof the globeof the globe

Penetrating injury of the globePenetrating injury of the globe

• Beat something with a hammer, splashing pieces to Beat something with a hammer, splashing pieces to eyeeye

• The severity of penetrating injury is related to many The severity of penetrating injury is related to many factorsfactors

SizeSizeShapeShapeCharacter of instruments causing traumaCharacter of instruments causing traumaSplashing velocitySplashing velocityInjured siteInjured sitePolluted degree Polluted degree

Penetrating injury of the globe – Penetrating injury of the globe – clinical findingsclinical findings

• Direct damage to ocular tissueDirect damage to ocular tissue– Corneal penetrating injury Corneal penetrating injury

– Prolapse of intraocular contentsProlapse of intraocular contents

– Secondary glaucomaSecondary glaucoma

– Traumatic cataractTraumatic cataract

– Intraocular hemorrhageIntraocular hemorrhage

Severity of penetrating injurySeverity of penetrating injury

• Endophthalmitis---Intraocular infectionEndophthalmitis---Intraocular infection

• Intraocular foreign bodyIntraocular foreign body

– Inflammatory reactionInflammatory reaction

– Metal foreign body may harm intraocular tissueMetal foreign body may harm intraocular tissue

• Sympathetic ophthalmiaSympathetic ophthalmia

– Sometimes penetrating injury or intraocular foreigSometimes penetrating injury or intraocular foreign body in one eye leads to severe uveitis in another n body in one eye leads to severe uveitis in another eye which is called eye which is called sympathetic ophthalmiasympathetic ophthalmia

Penetrating injury of the globe - Penetrating injury of the globe - treatmenttreatment

• Don’t squeeze injured eye on examinationDon’t squeeze injured eye on examination• Emergency treatment Emergency treatment clean the woundclean the wound instill antibiotic ointment and bandage both eyesinstill antibiotic ointment and bandage both eyes transmit the wounded to hospital in timetransmit the wounded to hospital in time tetanus antitoxintetanus antitoxin• Corneal, scleral wound should be sutured as early as possibleCorneal, scleral wound should be sutured as early as possible• As for corneal or scleral wound with prolapse of the uvea, if it As for corneal or scleral wound with prolapse of the uvea, if it

is within 24 hours, the wound is clean, the prolapsed tissue mais within 24 hours, the wound is clean, the prolapsed tissue may be replaced into the eyey be replaced into the eye

Penetrating injury of the globe - Penetrating injury of the globe - treatmenttreatment• In order to prevent iris incarceration, injection of air iIn order to prevent iris incarceration, injection of air i

nto the anterior chamber should be donento the anterior chamber should be done

• For the corneal line wound which is less than 3mm wiFor the corneal line wound which is less than 3mm with no incarceration, the anterior chamber is restored alth no incarceration, the anterior chamber is restored all or partially, suture isn’t neededl or partially, suture isn’t needed

• Minor and closed scleral wound needn’t be sutured Minor and closed scleral wound needn’t be sutured

• Inject antibody into subconjunctivaInject antibody into subconjunctiva

• Examination next dayExamination next day

Intraocular foreign bodyIntraocular foreign body

Intraocular foreign Intraocular foreign bodybody

• Commonly occurred in eye injuryCommonly occurred in eye injury• Steel, iron, copper, non – metal foreign bodySteel, iron, copper, non – metal foreign body• In the anterior chamber, lens, vitreous, incarcerated in In the anterior chamber, lens, vitreous, incarcerated in

the retinal and uveathe retinal and uvea• Stable substance such as gold, silver, glass, stone and Stable substance such as gold, silver, glass, stone and

etc may lead to simple exudative reaction surroundinetc may lead to simple exudative reaction surrounding the foreign bodyg the foreign body

• Steel and iron within the eye bring about severe reactiSteel and iron within the eye bring about severe reactionon

Intraocular foreign body - Intraocular foreign body - diagnosisdiagnosis

• Injury historyInjury history

• SignsSigns

• Ocular examination Ocular examination

• X rayX ray

• CT CT

Preoperative examinations

Visual acuitySlit lamp examinationDirect and indirect Ophthalmoscopy (mydriatic)B-scan

Intraocular foreign body - Intraocular foreign body - treatmenttreatment• Magnetic IOFBMagnetic IOFB

– In the anterior chamberIn the anterior chamber– In the lensIn the lens– In the posterior part of the globeIn the posterior part of the globe

• Non–magnetic IOFBNon–magnetic IOFB– In the anterior chamberIn the anterior chamber– In the lensIn the lens– In the posterior part of the globeIn the posterior part of the globe

ReviewReview

• Classification of ocular injury ?Classification of ocular injury ?

• Harm of penetrating injury of the globe ?Harm of penetrating injury of the globe ?

• Treatment of penetrating injury of the globe ?Treatment of penetrating injury of the globe ?