TMA

Department of eye diseases

Ocular traumas
 Types of Eye Injury

 There are a great variety of possible eye injuries but

they tend to fit into the following basic types.
 Blunt ocular traumas
 Penetrating ocular traumas
 Non-penetrating ocular traumas
 Chemical eye injuries
 Minor superficial eye injuries:
 corneal abrasions
 corneal and conjunctival foreign bodies
 conjunctival lacerations
 Eyelid injuries
 Orbital injuries and fractures
 Burns of cornea, conjunctiva and eyelid
 Distribution


Burns
Penetrating eye injuries

Non-penetrating 6
2
eye injuries
10
%
80

Blunt injuries
Blunt trauma of soft tissues and
orbit
Injuries are divided by localization:

Blunt traumas of soft tissue and orbit

Closed fractures of orbit
Blunt traumas of soft
orbital tissues

Signs:
- Subconjunctival haemorrage
- Haematoma of eyelids
- Absence of ocular movements
 Orbital fractures

signs:
- diplopy
- enoftalm
- absence of ocular
movements
 Orbital fractures
а

b
c
a) Fractura of medial wall of the
eye ( emphyzema of eyelids)
b) Fracture of lateral and inferior
walls of orbit of right eye
с) Fracture of the superior wall of
orbit, haematoma of eyelids
 First-aid tactics

 First aid for injuries of surrounding soft

tissues: on-site imposition of cold for 1-2
hours (ice, wet wipes).
 Maintaining hemostatic vasoconstrictors
(menadione, vitamin K, Ascorutinum
calcium chloride 10%).
 Immediately send to ophthalmologist.
Blunt injuries of eye (contusion)
Divided according to severity:
Mild - complete recovery
 Medium - small residual symptoms do not
affect visual function
 Severe - there are large morphological and
functional disorders
 Very severe - Rough morphological
changes, loss of function
Blunt injuries of the eye

Mechanism of eyeball contusion (schematic view)

Blunt injuries of the eye

Signs:
 Subconjunctival haemorrage
 Corneal erosion
 Hyphaema
 Haemophthalm (vitreous haemorrhage)
 Iridodonezis (trembling of iris)
 Mydriazis
 Subluxation of lens
 Iridodializis (detachment or tear of the iris)
 Choroidal or retinal ruptures
 Retinal detachment
 Avulsion of an optic nerve
 Choroidal or retinal ruptures

Oedema of the cornea and

Ruptura of the pupillae
hyphema
 Blunt injuries of the eye

Iridodializis
Dislocation of the lens
 Blunt injuries of the eye

Choroidal ruptures Choroidal ruptures and

partial haemophthalmos
 Horoidal or retinal ruptures

Traumatic avulsion of optic

nerve
Retinal detachment
 Blunt injuries of the eye

Subconjunctival ruptures of eye

First-aid tactics

 Instillation into the conjunctival sac

of antibiotics or sulfa eye drops
 Anesthesia (local and general)

 Easy aseptic bandage

 Immediately send to ophthalmologist

Injuries of surrounding
tissues
By localization injuries are divided into:

 Injuries of eyelids

 Lacrymal ducts injuries

 Foreign bodies
 Injuries of eyelids

Lacerative crush wound

of lower eyelid Lacerative crush wound
of upper and lower eyelids
Lacrymal ducts injuries

Laceration of the lower eyelid, with injury

of lacrimal duct
Foreign bodies of the orbit

Wooden foreign body is located in the

right orbit and labyrinth (MRI)
First-aid tactics

 Tetanus toxoid
 Washing the wound with disinfectant
solutions
 Parenteral (i/m) administration of
antibiotics
 Easy aseptic bandage
 Immediately send to ophthalmologist
 Wounds of an eyeball
 Divided by localization:
- Corneal wounds
- Scleral wounds
- Corneoscleral wounds
- By penetrating of external walls
- Penetrating injury
- Non-penetrating injury
- Penetrating injuries are divided into 2:
- With intraocular foreign body
- With exit of intraocular tissues from the wound
 Wounds of an eyeball

Penetrating injury of cornea, Penetrating injury of cornea,

absence of anterior chamber anterior chamber is present
 Eyeball injuries

Penetrating injury of cornea Penetrating corneaal wound

with exit of iris complicated with lens
opacification
 Eyeball wounds

Penetrating wound of sclera Corneoscleral penetrating

with exit of iris injury with foreign body
 Injuries of an eyeball

Borders of cornea are Penetrating scleral wound

adapted, penetrating wound with foreign body.
with foreign body in anterior
chamber.
First-aid tactics

 Tetanus toxoid
 Washing the wound with disinfectant
solutions
 Parenteral administration of antibiotics
 Binocular aseptic bandage
 Immediately send to ophthalmologist
 Treatment tactics

 Performed by ophthalmologist in specialized

clinics:
- X-ray of the orbit in the front and lateral
projections
- X-ray of orbit by Komberg – Baltin
- Primary surgical treatment of wounds
- Reconstructive operations routinely if necessary.
 Injuries of eyeball
Severe complications after penetrating
wounds of the eyeball

 Endophthalmitis

 Panophthalmitis

 Sympathetic ophthalmia
Thermic and chemic burns of
eyes
Burns of eyelids and conjunctiva are
divided by severety

I (mild) degree - redness and swelling

II (average) degree – bubbles
III (severe) degree - ischemia and necrotic zone
IV (very severe) degree - necrosis
 Thermic and chemic burns of
eyes
Classification by severety:
I (mild) degree – hyperemia of eye tissues,
oedema, superficial corneal erosion.
II (medium) degree – deep corneal erosion,
oedema, ishchemisation of conjunctiva and
limbus area
III (severe) degree – in addition to the above
mentioned corneal opacification like misted
glass in the necrotic zones
IV (very severe) degree – porcelain cornea, total
necrosis of conjunctiva, perforation
 Thermic and chemic burns of
eyes

Mudium degree of chemical Medium degree of chemical

burn of conjunctives. burn of corneal layer
Ischemic zone of lymbic
area
 Кўз олмаси термик ва
кимёвий куйишлари

chemical burns of the eyeball

chemical burns, severe lens is extremely severe
 Кўз олмаси термик ва
кимёвий куйишлари

chemical burn extremely chemical burn extremely

severe. complications of severe. edematous cataract,
cataract lens secondary glaucoma
 Thermic and chemic burns of
eyes

Very severe thermic burn Very severe thermic burn

 Thermic and chemic burns of
eyes

Very severe thermic burn of eyeball and surrounding

tissues
 Thermic and chemic burns of
eyes

Severe theromochemical burn ofVery severe thermochemical burns,

an eyeball. 1 month after the complicated cataract
injury.
 First-aid tactics
 Removing of burn agent
 Washing the conjunctival sac during 10-15 minutes.
 Using buttered solutions
 Immediately send to ophthalmologist
In the hospital:
 Anesthesia
 Washing of lacrimal ducts
 The introduction of autologous blood under the
conjunctiva
 In case of severe burns, tetanus toxoid injection
 Disinfecting, vitamin solutions
 Parenteral injection of antibiotics
 Binocular aseptic bandage
Thermic and chemic burns of
eyes

 the outcome of burns mild to moderate

favorable
 burns of moderate and severe usually leave
behind changes require surgery
 children with complications from burns of
moderate and severe group are entered in
the prevention of ocular pathologies and for
a long time kept under medical observation
Prophylaxis of ocular traumas

Prevention consists of two stages:

The first step, i.e. Primary prevention - preventive
measures among the population at home, on the
streets, in schools, kindergartens.
The second stage, i.e. secondary prevention - early
diagnosis, urgent measures to actively integrated
medical and surgical treatment to help to prevent
dangerous complications such as purulent and
phacogenic uveitis, metallosis, hypotension eyeball and
sympathetic ophthalmia.