EYE-REVISE

• Types of trauma

  • chemical ​

  • mechanical 

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Surface injuries

• sub-conjunctival haemorrhage​

  • ​in itself benign although looks dramatic​

  • may indicate serious underlying injury - foreign body, perforation, non-accidental injury in child​

• abrasions

  • loss of corneal epithelium as a result of scrape by foreign object​

• foreign bodies

• Suspect penetration of globe if no foreign body seen 

  • even when symptoms and signs minor or normal ​

  • xray can be useful to visualise radio-opaue IOFB​

  • likely to also need CT scan

• May be associated with significant trauma elsewhere

  • If see significant injury to eye, be suspicious of injury elsewhere around head and neck

  • Patients with significant trauma may often also sustain ocular injury – should be part of secondary survey

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Chemical injury

• More commonly missed

• Especially alkalis, also acids – damage surface of eye

• Alkali more dangerous as can penetrate intact cornea, but acid tends to cause scarring at site of contact – limits penetration

• Patients tend to know they have happened, but may present days later as eye feels gritty, sore, vision blurred, red eye

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IOFB

• An IOFB (intra-ocular foreign body) may be painless with minimal signs and vision of 6/6

• Because eye has property that means small lacerations tend to self-seal

  • unless something directly in visual axis, small foreign bodies may go relatively unnoticed

• Mechanism of injury is key

  • if patient involved in high velocity foreign body injury, important to examine thoroughly to make sure nothing has gone into the eye

• Minor injuries in form of bit of metal or foreign body on surface of eye

  • patients present early as exquisitely painful, definite foreign body sensation, blurring of vision

• With good history of event and good examination to exclude more serious pathology, can usually locate foreign bodies and deal with them appropriately