29. Trauma

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29. Trauma
2013-11-13 07:01:06

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  1. Closed injury
    ocular wall intact by intraocular damage
  2. Contusion?
    • closed wound caused by blunt trauma
    • injury direct/2ndy to shape of globes
  3. Open injury?
    full thickness wound to cornea or scleral wall
  4. Rupture?
    open injury 2ndy to blunt trauma where globe gives way at weakest pt
  5. Laceration?
    • openinjury
    • fyll thickness wound caused by sharp object
  6. Penetration?
    • single full thickness injury caused by sharp object
    • possible retention of intraocular fb
  7. Perforation?
    penetrating injury with entry and exit wound
  8. Blunt trauma?
    • ant/post compression of equatorial expansion
    • majority of impact absorbed by lens-iris-vitreous
    • transmission of force to post- manifestations
  9. Anterior segment manifestations?
    • ciliary shock
    • lens: subluxation
    • globe rupture
    • cornea: abrasion, edema hyphaema
    • iris: vossius ring, traumatic mydriasis, iridodialysis
  10. Traumatic iritis?
    • moderate blunt injury
    • photophobia
    • lid bruising/edema
    • subconj haem
    • sluggish pupil
    • REFER
  11. Commotio retinae?
    • intracellular edema within PR and RPE 2nd to shock waves in vitreous
    • cloudy grey white retina- demarcated boundary
    • macula: berlin's edema
    • tx: resolves 6w
    • complications: pig degen, retinal hole
  12. Choroidal rupture?
    • tear in choroid: bruch's RPE
    • obscured by haem
    • white-yellow crescen shaped vertical streak
    • sight threatening
    • FA
  13. Retinal breaks
    • predispose RD
    • dilated fundus exam
  14. Traumatic optic neuropathy?
    • nerve appears normal- haem
    • atrophy over weeks
    • VA and RAPD
    • cause: compression from haematoma/fb
    • deceleration injury
  15. Optic nerve avulsion?
    • nerve tears at lamina cribosa- sudden rotation of globe
    • raised iop or sudden retroplusion
    • tx: not possible
  16. inflammatory fb reaction?
    • severe: iron-retinopathy/cataracts/glau, coper- retinopathy/golden plaques/sunflower cataract
    • mild: nickel, al, hg, zn, grass
    • none: carbon, lead, rubber, plastic, glass
  17. Purtsher's retinopathy?
    • head trauma+compressive injury to trunk
    • sx: CWS, haem ON, opacification of retina, Roth's spot
  18. Terson's retinopathy?
    • subarachnoid haem
    • blood between ILM and retina- may perforate vitreous
    • sudden rise in ICP
    • HA, Papilloedema and vomitings
  19. Valsalva retinopathy?
    • sudden increase in intraab/thoraic pressure-> IO venous pressure-> rupture of caps
    • vit/intraret haem
    • trivial: lifiting, straining, coughing, vomting
  20. Shaken baby syndrome?
    • diffuse retinal haem, CWS, papilloedema, vit haem infants
    • intracranial vleeds, cerebral contusions
    • cause: violent shaking
    • bruise, soft tissue injuries, fractures
  21. orbital floor blow out fracture
    • increase orbital presuure
    • thin bones floor
    • pain, diplopia, edema, enophthalmos
    • tx: antibiotics, steroids, nasal decongestants
    • aim to prevent perm diplopia