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By ULY CLINIC

 

Ocular Trauma

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Introduction

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These are eye injuries that may result from blunt or sharp objects or from chemical substances. The management of these injuries is guided by history from the patient and ocular findings by the clinicians. Classes of ocular trauma are as follows:-

Blunt Trauma/Perforating Eye Injury/Foreign Body 

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Establish the cause to determine the type of injury and whether there is penetration.  

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Diagnostic Criteria

  • Corneal abrasion/laceration with or without an imbedded foreign body.  

  • Eye lids may also be involved. 

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Investigations

  • This is done after the first aid measures

  • Test the visual acquity

  • Examine the injured eye with slit lamp or magnifier including fluorescein staining to reveal foreign body or corneal laceration 

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Non-Pharmacological Treatment

  • Provide first aid measures to the patients as per presentation

  • If no penetration, irrigate the eye with clean water or Ringers Lactate to reduce chemical substance in the eye 

  • Remove foreign body if visible with a cotton bud or surgical blade if shallow. 

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Pharmacological Treatment

At the primary care:

 

Corneal Abrasion: 

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  • Chloramphenical eye ointment 1%, 8 hourly to the injured eye until no fluorescein staining  

 

Steps Guiding Management of Complicated Blunt Trauma

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Complicated blunt trauma is a trauma where the vision is poor, patinets experiences pain and there is hyphaema. It is best managed by eye specialist as surgery may be required in the management.  

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Steps guiding management of complicated blunt trauma 

Steps guiding management of complicated

Deep Corneal or Scleral Injuries

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  • Apply an eye shield or pad with no pressure and refer immediately 

  • While waiting for referral, use the following in the affected eye: 

 

  • Chloramphenical 1% eye drop, 2 drops OR ointment, stat

AND

  • Atropine 1%, 1–2 drops stat AND A: Tetanus toxoid 0.5 ml IM stat as prophylaxis   

AND

  • Paracetamol 1 gm 4–6 hourly to a maximum of 4 doses in 24 hours, for 3 days in adults, the dosage in children is 10–14 mg/kg 4–6 hourly for 3 days. 

 

Referral indicated if 

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  • Intraocular foreign body is suspected

  • There is globe or intracocular penetration evidenced by:

  • Poor vision,

  • Distorted pupil

  • Ocular contents of foreign body is seen

  • Circumferential subconjunctival haemorrhage

  • Hyphaema with or without raised intraocular pressure

  • Conjuctival laceration requiring suturing (>1 cm)

  • Laceration/perforation or diffuse damage to the cornea and sclera

  • Chemical and thermal injuries

  • Damage to ocular adnexa including eyelids

  • Limited ocular movements 

 

Surgery

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This is done by a well trained eye specialist at the District, Regional, Zonal and National hospital. It should be done within 48 hours of injury. 

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Note: 

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  • Eye ointment should be applied very gently and in the lower fornix (behind the lower eyelid). 

  • Do not apply pressure on the eye in perforating injuries of the eyeball

  • Delay in surgical management of the injury may cause irreversible blindness or may necessitate removal of an eye 

 

Referral

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  • Immediately refer the patient to a health facility with eye surgeon

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Chemical Injuries/Burn 

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This is an Ophthalmological emergency. It occurs when chemicals such as acid or alkali (e.g household detergents, bleaching agents), snake spit, insect bite, traditional eye medicine, cement or lime cause a damage to the eye.    

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Diagnostic Criteria

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  • Diagnosis relies mostly with patients’ history 

  • Patients may present with photophobia

  • Inability to open the eyes 

  • Excessive tearing/watery eye 

  • Cloudiness of cornea with blurred vision

  • Loss of conjunctival blood vessels

  • Traces of chemical substance such as cement or herbs and blisters or loss of eyelid skin in open flame injuries.  

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Non-Pharmacological Treatment

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If a patient gives you history of being in contact with the items mentioned above, the following should be done:

  • Irrigate the eye with clean water or Ringers lactate continually for a minimum of 20–30 minutes to reduce chemical substances. Irrigate longer for severe alkali burn.

  • Test the patients’ vision and examine the patient’s eye 

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Pharmacological Treatment

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  • Tetracaine 0.5% eye drops, instill 2 drops in the affected eye. Repeat irrigation if possible. Evert the eye lids and remove the debris

AND

  • Chloramphenical 1% eye ointment, apply 6 hourly to prevent infection for 3 days.

AND

  • Paracetamol 1 gm 4–6 hourly to a maximum of 4 doses in 24 hours, for 3 days in adults, the dosage in children is 10–14 mg/kg 4–6 hourly for 3 days

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Referral

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  • Refer all cases within 12 hours to eye specialist 

 

Updated on, 2.11.2020

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References

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1. STG 

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