BLUNT TRAUMA TO EYE VARIOUS FINDINGS

Blunt trauma to the eye can result in a wide range of findings and injuries, depending on the force and direction of the impact.

The Trauma can be due to

1. Direct Injury
2. Contre-coup Injury
3. Shearing forces and shock waves.

The eye is a delicate organ with several components, and trauma can result into open or closed globe injuries. Following are some of the findings and injuries commonly associated with blunt trauma to different components of the eye:

       Eyelids and Surrounding Tissues:

ü  Contusions and bruising of the eyelids and periorbital area. May give an appearance of Raccoon Eyes.

ü  Lacerations or cuts on the eyelids.

ü  Swelling and edema of the eyelids.

       Conjunctiva:

ü  Subconjunctival hemorrhage, which appears as redness on the white part of the eye.

ü  Chemosis, which is swelling of the conjunctiva.

       Cornea:

ü  Corneal abrasions or scratches, causing pain, redness, and foreign body sensation.

ü  Corneal edema, which can result in blurred vision.

ü  Lamellar, Partial or full thickness tear.

       Sclera:

ü  Scleral rupture, which is a severe injury that can lead to prolapse of the intraocular contents and loss of the eye's integrity. The sclera is thinnest at the equator; hence occult posterior equatorial injuries are common.

       Anterior Chamber:

ü  Hyphema, which is the presence of blood in the front chamber of the eye, causing vision impairment and increased intraocular pressure.

ü  Traumatic iritis, which is inflammation of the coloured part of the eye (iris) leading to pain and photophobia (sensitivity to light).

       Iris

ü  Iridodialysis - It is the separation of the iris root from the ciliary body. It is described as D-shaped with a biconvex area adjacent to the limbus best visible on retro illumination. (uni-ocular double vision may occur)

ü  Iris stromal tears - Tears in the iris stromal tissue

ü  Iris Prolaspe

ü  Iridoplegia

       Lens:

ü  Traumatic cataract (complex), where the lens becomes cloudy or opaque due to injury. Rosette Cataract is the most specific in Blunt Trauma.

ü  Lens dislocation or subluxation.

ü  Vossius ring - Ring-shaped impression of the pupillary margin over the anterior lens capsule due to blunt trauma

       Vitreous:

ü  Vitreous hemorrhage, which is bleeding into the gel-like substance (vitreous humor) inside the eye. Will result in floaters in field of vision.

ü  Vitreous detachment, where the vitreous separates from the retina.

       Retina:

ü  Retinal detachment, a serious condition where the retina peels away from the back of the eye, causing vision loss.

ü  Retinal tears or breaks, which can lead to detachment if left untreated.

ü  Commotio retinae refers to traumatic retinopathy secondary to direct or indirect trauma to the globe.Commotio retinae in the posterior pole is also referred to as Berlin's edema. Macular edema, swelling of the central part of the retina (macula), affecting central vision. A pseudo cherry red spot may be seen when commotio involves the fovea.

(Remember Cherry red spot is a significant fundoscopic finding in the macula, observed in central retinal artery occlusion (CRAO) and a variety of lipid storage disorders)

ü  Proliferative Retinopathy may occur

ü  Macular cyst, hole or degeneration may occur in blunt trauma.

       Optic Nerve:

ü  Optic nerve injury or traumatic optic neuropathy, which can result in visual field defects or even permanent vision loss.

ü  Avulsion or Tear of Optic Nerve may occur in rare cases.

       Globe Rupture:

ü  Full-thickness injury to the eyeball, causing loss of intraocular contents and severe visual impairment.

ü  May give rise to critical conditions like sympathetic ophthalmitis later on. Endophthalmitis and Pan-ophthalmitis can occur.

Apart from this there may be associated orbital wall fractures as discussed in class.

INVESTIGATIONS

§      Visual Acuity

§              SLIT LAMP Examination

§              Intraocular Pressure

§              Gonioscopy

§              Fundoscopy and Fundus Photography

            Fluorescein Staining

§              Seidel's Test

§              X-Ray

§              B Scan Ultrasonography

§              Computed Tomography

§              Magnetic Resonance Imaging

            Electrodiagnostic Tests (VEP)

§              Optical Coherence Tomography

 

©Subha Deep (Dr. Subhadeep Shit)

(PGT- MD Emergency Medicine)

www.emdocindia.com

This note is a synopsis for revision of the class taken for 3^rd year students (MBBS) on 2^nd September 2023. Rely on Test Books for comprehensive knowledge.