眼科学课件：04 Ocular Trauma

1、Depart. Of OphthalmologyDepart. Of Ophthalmology RenjiRenji Hospital HospitalIntroduction Definition： The direct effect of mechanical, physical and chemical factors on the eye and ocular adnexa leads to injury of structure and function A common cause of unilateral blindness in children and young adu

2、lts, especially men Classification： Factors: mechanical, physical, chemical Mechanical factors: Closed: contusion, lamellar laceration Open: rupture, lacerationCharacteristics Vulnerability: due to position Transparency: scarring, slow metabolism Threaten of Sympathetic ophthalmia (SO) More Complica

3、tionsRepairing and HealingRegeneration： The same cell divides and proliferates ：conjunctiva, cornea ：muscular tissue ：nervous tissue Principles of Examination No delay in first aid No increase in injury and pain Avoid omission Principles of Treatment Whole body Eye Intraocular External eye Visual fu

4、nction ApperancePosition External eye: eye lid, lacrimal apparatus Anterior segment: conjunctiva, cornea, anterior chamber, iris, ciliary body, lens Posterior segment: vitreous, choroid, retina, optic nerveClosed Eye Trauma: Contusion Definition： The eye globe is intact, but the direct effect of mec

5、hanical factors on the eye leads to injury of structure and function Characteristic：Most common lots of clinical manifestations Eye lids Contusion Hematoma Most common Better prognosis Prognosis depends on the damage extent of intraocular tissuesLaceration of eye lid Laceration of canaliculiCorneal

6、Contusion Corneal epithelium injury： Full of sensory nerves Pain Corneal stroma injury： Edema Affect visual acuityIris Rupture of iris sphincter Shape of pupil Diameter of pupil Light reflex Photophobia to varing degreeIris Iridodialysis Half-moon-shaped defect of the root Dicoria: monodiplopia D-sh

7、aped pupilIris Iridodialysis (extensive) In severe trauma Mostly accompany damage of posterior setment Worse prognosis Treatment: use special intraocular lens (black-diaphragm IOL ) Anterior Chamber Hyphema Rupture of iris vessels Seriously affect vision Keep an eye on intraocular pressure Prevent c

8、orneal blood staining Bandage both eyes to prevent movementRecession of Anterior Chamber Angle Seperation of circular and longitudinal ciliary muscles Iris root is shifted backward Anterior Chamber is deeper Scar formation in the angle The outflow of aqueous is obstructed Leads to secondary glaucoma

9、 Clinical examination: Gonioscopy, ultrasound biomicroscopy (UBM)Lens Traumatic Cataract Capsule ruptured: progress fast Secondary glaucoma Lens-induced Uveitis Capsule unruptured: progress slowLens Dislocation Partial lens dislocation & Complete lens dislocation Affect visual acuity Partial len

10、s dislocation: monodiplopia Cause lots of complicationsPosterior Segment Contusion Vitreous hemorrhage: rupture of vessels of ciliary body, retina, choroid Choroidal contusion: rupture, bleeding Retinal contusion: concussion (transient), macular hole, retinal detachmentOpen Eye Trauma Definition：The

11、 globe integrity is disrupted by full-thickness entry wound and may be associated with prolapse of the internal contents of the eye Classification： Positions: Cornea, Sclera, Limbus Types: Penetration, Perforation, Rupture Weakness points of eyeball：Limbus, rectus insertion site Principles of treatm

12、ent：Close wounds timely, Prevent infection, Avoid complicationsPenetration Sharp instrument Injury, Single Wound Penetration of cornea and/or sclera Prolapse of iris Pupil deformationPerforation Sharp instrument Injury, Double Wound Entrance and Exit wound Quite severe typeCorneal Penetration, Traum

13、tic Cataract, HyphemaAfter Suturing of Corneal PenetrationForeign Bodies Cornea (Closed) Common Remove foreign body timely Prevent infectionForeign Bodies Intraocular (Open)Definition：The foreign body penetrates the eyeball and remain inside the eyeCharacteristics：Common in mechanical injuries Size

14、Property Position Diagnosis：Carefully examination Treatment：Remove foreign body timelyForeign Bodies lensCapsule unrupturedCapsule rupturedMetal foreign bodiesForeign Bodies RetinaOcular Siderosis： brownish yellowOcular Chalcosis： yellowish greenSympathetic Ophthalmia (SO) Definition：is a bilateral

15、diffuse granulomatous uveitis (a kind of inflammation) of both eyes following trauma to one eye Can leave the patient completely blind Pathophysiology：Autoimmune inflammatory response toward ocular antigens Diagnosis：Clinical, seeking a history of eye injury High risk factors: Poor wound healing Sev

16、ere inflammatory reaction Intraocular tissues incarcerating Intraocular foreign body remaining Repeated surgeries High time: 2-8weeks Clinical manifestations: Early stage: mild Medium-term: uveitis Late stage: sunset-glow fundus Prevention and Treatment Resolve high risk factors Control uveitis Rega

17、in visual function Enucleation or EviscerationChemical Eye Burns Definition：occur when the eye comes into contact with a solid, liquid, or gas chemical. The severity of the burn depends on the chemical, as well as the amount that comes into contact with the eye Classification： Which one is more seri

18、ous? Alkali Burns Acid Burns Alkali Burns: Proteolysis and diffusion Ill-defined Deep wounds Poor prognosis Acid Burns: Protein coagulation / denaturation and barrier formation Well-defined Shallow wounds Good prognosis Clinical Manifestations: Inflammation Repair Scarring Loss of function Prognosis: Contact area Concentration Rescuing timeEarly StageBurn of corneal epitheliumCorneal edemaCan figure the structure of anterior chamberLate StageCorneal white opacityCannot figure the intraocular structure Treatment： Field first aid: Rinse thoroughly with water for 3