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eye_injuries

Eye injuries

patient information sheets

introduction

  • patients with a possible open globe injury should be examined with extreme caution, and clinicians must avoid placing pressure on the globe (eg, with lid eversion or foreign body [FB] removal) or using eye drops until this injury is ruled out.

  • RED FLAGS
    • corneal laceration
    • mechanism suggestive of penetrating injury (eg. hammer, glass)
    • corneal infection - infiltrate in anterior chamber

open globe injuries

epidemiology and pathophysiology

  • 18-41% are caused by intraocular foreign bodies (IOFBs) of which 90% are metallic such as from motor vehicle accidents, lawn mowers, weapons, hammering on metal or stone, or machine tool use.
  • most IOFB's are found in the vitreous cavity.
  • lacerations may also be caused in young children from falling onto sharp objects such as scissors, pens, thorns or knives.
  • lacerations involve the cornea in ~2/3rds with the remainder involving the sclera
  • the globe may rupture from blunt trauma - usually at its weakest spot where the sclera is thinnest near the equator directly behind the insertion of the rectus muscles, or at sites of previous ocular surgery.

complications

  • extrusion of ocular contents
  • endophthalmitis
    • occurs in 2-7%, but higher in those with IOFBs (up to 13%), and particularly a risk if retained FB, organic FB (eg thorn) or delay in primary closure
  • traumatic cataract (late)
    • the most common late complication that limits vision
  • corneal scarring (late)
  • retinal detachment (late)

Mx of open globe injuries

high index of suspicion

clinical features

  • intraocular or protruding foreign body
  • obvious scleral or corneal laceration
  • volume loss to the eye
  • uveal prolapse (iris of ciliary body)
  • eccentric or peaked pupil
  • 360 degree, bullous subconjunctival haemorrhage suggesting posterior rupture
  • decreased visual acuity
  • relative afferent pupillary defect by swinging penlight technique

initial Mx in ED

  • keep nil orally
  • assess other injuries as per usual
  • do NOT remove any protruding foreign bodies
  • minimise increasing intraocular pressure:
  • do NOT use eye drops (eg. LA's, flourescein, cycloplegics]]
  • place eye shield after initial eye examination
  • begin iv antibiotics:
    • vancomycin + ceftazidime (or ciprofloxacin if penicillin sensitive)
  • immediate ophthalmology consult
  • CT scan of orbits with 1-2mm slices
    • CT findings of open globe injury include IOFB, intraocular air, eye wall deformity, volume loss of the eye, and irregular scleral contour
    • ocular CT has limited ability (sensitivity 56-75%) to demonstrate an occult open globe injury and should not be used as the sole determining factor for decisions regarding surgical exploration
  • urgent surgical repair, preferably within 24hrs of injury.

references and other resources

eye_injuries.txt · Last modified: 2018/09/10 08:44 by wh