Slide Guide

Appendix A 
Ocular Trauma

SLIDE A1  Title Slide

■■ Introduce the topic and explain to students that, based on their preparation for the
course, a series of questions will be asked throughout the lecture. Their active partici­
pation and responses are expected.
■■ Emphasize that this lecture summarizes the information provided throughout the
course, and that all major components will be covered in depth during individual
lectures, skill stations, and demonstrations.
■■ Because you will use the slide show to emphasize key points, it is important to be
familiar with every slide. Proper sequencing of questions and responses facilitates an
interactive presentation.
■■ Be sure to carefully manage the time allotted for this lecture.

SLIDE A2  Case Scenario

■■ Emphasize the importance of obtaining information about the history of the event
(e.g., blunt or penetrating trauma or chemical exposure), medications, previous eye
surgery, and presence of contacts.
■■ What are the initial symptoms and acuity?
■■ How would you examine her eye?
■■ What injuries might require emergency management and ophthalmologic consul­
tation?

SLIDE A3  Objectives

■■ These objectives relate to the lecture/interactive discussion. There may be additional
objectives related to this topic that will be covered in the skill stations and the initial
assessments. Please refer to the Student Manual for the complete list of objectives
related to this topic.

     1
­2    CHAPTER 8  n  Musculoskeletal Trauma

SLIDE A4  Assessment Principles

■■ Emphasize the importance of a systematic exam.

SLIDE A5  Outside to Inside

■■ The principles of eye examination are to systematically move from the external
structures of the eye and proceed to the ophthalmoscopic examination.

SLIDE A6  Assessment and Management

■■ Photograph shows globe laceration and lid injury.
■■ Any lid injury should alert the examiner to possible underlying eye injuries.

SLIDE A7  Assessment and Management

■■ Photograph shows a medial canthus laceration.
■■ Consider lacrimal duct or lacrimal sac injury.
 CHAPTER 8  n  Slide Guide    3

SLIDE A8  Assessment and Management

■■ Photographs show the technique for examination of the conjunctival surface of the
eyelid for injury or foreign bodies.

SLIDE A9  Assessment and Management

■■ Photograph shows foreign body of eyelid.
■■ Note the foreign body can be seen only when eyelid eversion technique is utilized.

SLIDE A10  Assessment and Management

■■ Photograph shows retained foreign body corneal ulcer.
■■ Emphasize the importance of finding foreign bodies early. If retained, they may cause
ulceration.

SLIDE A11  Assessment and Management

■■ Photograph shows impaled foreign body.
■■ Impaled foreign bodies should not be removed in the ED. These patients should be
referred for ophthalmological consultation.
­4    CHAPTER 8  n  Musculoskeletal Trauma

SLIDE A12  Assessment and Management

■■ Photograph shows fluorescein stain and abrasion.
■■ Fluorescein is adsorbed to injured cells.
■■ Fluorescein and blue light facilitate identification of corneal injuries.

SLIDE A13  Assessment and Management

■■ Photographs show corneal foreign bodies.
■■ Corneal foreign bodies may be removed with irrigation with a balanced salt solution.
■■ Topical anesthetic will aid in pain control and thus examination and removal.

SLIDE A14  Assessment and Management

■■ Eye patches are optional.
■■ Studies show no advantage in patient comfort or time to healing.

SLIDE A15  Assessment and Management

■■ Photograph shows hyphema.
■■ Blood in the anterior chamber indicates severe ocular trauma.
■■ 7% of patients with hyphema will get glaucoma.
 CHAPTER 8  n  Slide Guide    5

SLIDE A16  Assessment and Management

■■ Photograph shows iridodialysis, which is disruption of the iris from the ciliary body.

SLIDE A17  Assessment and Management

■■ Photograph shows traumatic cataract.
■■ Lens contusion may lead to later opacification and cataract formation.

SLIDE A18  Assessment and Management

■■ Photograph shows subluxed lens in anterior chamber.
■■ Blunt trauma can cause disruption of the zonular fibers that encircle the lens, resulting
in subluxation.

SLIDE A19  Assessment and Management

■■ Photograph shows vitreous hemorrhage.
■■ Tear of retinal vessels may be seen in the vitreous.
■■ Usually causes profound vision loss.
■■ Doctor may not be able to do funduscopic exam.
­6    CHAPTER 8  n  Musculoskeletal Trauma

SLIDE A20  Assessment and Management

■■ Photograph shows retinal hemorrhage.
■■ Blunt trauma may cause hemorrhage within the retina.
■■ Retinal detachment may be a late sequela.
■■ Visual impairment may occur if the macula is involved.

SLIDE A21  Assessment and Management

■■ Photographs show anterior globe rupture.
■■ Minimize manipulation of the eye to prevent further injury.
■■ Patch this condition with sterile dressing and eye shield.

SLIDE A22  Assessment and Management

■■ Photograph shows samples of eye dressings.
■■ Eye dressings don’t help with corneal abrasions, but should be used with more serious
ocular injuries.

SLIDE A23  Assessment and Management

■■ Photographs show intraocular foreign body in the anterior chamber.
■■ This condition requires ophthalmologic consultation for removal in the operating
theater.
 CHAPTER 8  n  Slide Guide    7

SLIDE A24  Assessment and Management

■■ Photograph shows intraocular foreign body.

SLIDE A25  Assessment and Management

■■ Photograph shows alkali burns.
■■ Alkali burns cause more severe injury than acid burns and can lead to ocular opacifica­
tion.
■■ Treat with copious and continuous irrigation.

SLIDE A26  Assessment and Management

■■ Photograph shows orbital blow-out fracture.
■■ Fracture of the bones of the socket may lead to muscular entrapment within the frag­
ments, or herniation of the periocular tissues into the maxillary sinus, leading to later
enophthalmos.
■■ Operative treatment may be delayed for up to two weeks.

SLIDE A27  Assessment and Management

■■ Radiograph shows orbit and maxillary sinus fractures.
■■ CT scan of the face with coronal reconstruction is encouraged.
■■ The orbital floor is not well visualized on axial cuts.
­8    CHAPTER 8  n  Musculoskeletal Trauma

SLIDE A28  Assessment and Management

■■ Photograph shows retrobulbar hematoma
■■ Immediate treatment is necessary to prevent blindness.
■■ This is a true ophthalmologic emergency.

SLIDE A29  Case Scenario

■■ Revisit the Case Scenario that was presented at the beginning of the slide set to give
students the opportunity to apply what they’ve learned in this lesson.

SLIDE A30  Questions

■■ Allow for adequate time for additional questions from the students and further discus­
sion before proceeding to the summary slide.

SLIDE A31  Summary

■■ These summary points relate to the lecture/interactive discussion. Please refer to the
Student Manual for the complete Summary related to this topic.