Assessment of patient with OCULAR TRAUMA by Haider Khan (final yr)

Assessment of a patient with ocular Trauma
By Haider khan (Final yr.)
Aims
nTo asses the nature of trauma.
nTo asses the severity of trauma.
nTo plan the appropriate treatment modality.
nTo foresee the complications and take measures to prevent them.
History
Take Concise and accurate history recording;
n Name, Age, Sex, Occupation
n Presenting complaints
¨ Pain
¨Dimness of vision
¨Diplopia
¨Watering of eye
n Time of injury
nCircumstances of accident
nNature of causative agent
nImmediate actins taken
nPast ocular History
nAsk about pre trauma vision in both eyes
nAsk about previous eye disease, surgery or trauma
nPast Medical and Surgical history
nFamily Hx
nPersonal Hx
nSocioeconomic History

General Physical Examination
nGeneral condition body esp. head and neck
n Anemia
n Jaundice
nCyanosis
n Pulse Rate
n Temperature
n B.P
n Lymph nodes
n Respiratory Rate
Systemic Examination
¨ Cardiovascular System
¨ Respiratory System
¨ GIT
¨ Central Nervous System
¨ Genitourinary System
Ocular Examination
n Inspection of adnexae
¨ Inspect the eyelids for bruises, abrasion, swelling.
¨ Injuries at the medial canthus may involve the lacrimal canaliculi and lacrimal sac.
nInspection of Conjunctiva (Bulbar and Palpebral)
Visual Acuity:
Measure the visual acuity in both eyes, starting with the worst affected eye first.

nIs there light perception?
nIf fingers can be counted up to 1meter proceed to use Snellen’s Chart.


Extra Ocular Muscles Motility
n Orbital Floor Fracture (common In Blunt Trauma)
¨Vertical gaze may be impaired in effected eye due to entarppement of inferior rectus and inferior oblique muscles.

nMedial wall Fracture
¨Defective adduction and abduction if medial rectus is entrapped

PUPILARY REFLEX
Examine for its size,
Shape and
Reactivity to light
RAPD
Anterior Segment Examination
Perform on slit lamp, if not available
use ophthalmoscope
nCornea
¨ Use 2% superficial fluorescein stain to detect any corneal epithelium defect like abrasions and corneal ulcers
¨Look for corneal foreign bodies


Anterior Chamber
nLook for depth (normal2-3mm)
¨Shallow anterior chamber may be the sign of vitreous hemorrhage or iris prolapse
¨Deep ant. Chamber shows posterior globe rupture and vitrous extrusion or post trauma glaucoma.
nLook for contents
¨It may Show hyphema due to ciliary body disruption
¨Lens matter
¨Pus
Pupil
nLook for size, position, shape and reactivity to light and accomodation.
¨Traumatic mydriasis or transient miosis may be present in case of blunt trauma
¨Peak, tear drop are irregular shaped pupil shows globe rupture
Iris
Look For
nIris Pattern
nAny Gap or Hole (penetrating injury)
nForeign body
Lens
nThere may be
¨Lens dislocation
¨Subluxation
¨Traumatic cataract. (late complication)
¨Vossius’s Ring
Posterior Segment
nExamine
nVitreous Humor
noptic disc
nretinal vessel
nMacula
nIf posterior segment is not visible despite clear anterior chamber and dilated pupil consider
nVitreous hemorrhage
nRetinal detachment
nCataract
Image
Images
Intra Ocular Pressure
nIt should be measure in both eyes at the end
Measure IOP with;
¨Goldmann Tonometry
¨Tonopen
¨Pulsair 2000 Keeler
¨Schiotz Tonometer
nIOP is raised in blunt trauma and low in penetrating trauma.
Specific Investigation
nPlain radiograph (frontal, lateral, Water’s view)
nCT Scan (axial and coronal view)
nUltrasonography
¨B scan
nTo see retinal detachment, Incase of vitreous hemorrhage or lens cataract
nIncase of radiolucent foreign body.
nMRI
nMRI is contraindicated incase of any metallic intraocular foreign body.
nElectrophysiological tests.
¨Electroretinogram (ERG)
nFor retinal detachment.

Plain film X-Ray of IOFB
Axial CT Scan of Hit & Run Case
nThe blue arrow denotes a severely deformed right eye with hyper-dense signals within the globe (vitreous hemorrhage and blood clot).
CT of fracture
Ocular Trauma Score
The OTS provides a single probability estimate of an eye trauma patient will obtain a specific visual range by six months after injury.( tables of ocular trauma scoring couldn’t be uploaded)


GOD BLESS YOU

Images couldn’t be included