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History
The details of the traumatic event , such as when , where , and how , will
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A |
B |
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indicate the degree of injury . The |
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subsequent course of action taken |
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by the patient , for example , immediate |
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versus delayed seeking of |
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medical attention , determines the |
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risk of complications and the prognosis |
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. If the injury is related to hitting |
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metal on metal or is a high velocity injury , there may be an |
Figure 3 . Slit lamp views . |
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intraocular FB .
Examination
The level of vision needs to be assessed . If the patient is unable to see letters , vision can be assessed by methods such as counting fingers at 40cm , or hand movement , such as sideways , or up and down , or the perception of light . It is critical to document the level of vision for both prognostic and medicolegal reasons .
Patients with non-penetrating injuries tend to have better vision , unless the central cornea is involved . With non-penetrating injuries there will be an epithelial defect and possibly deeper stromal damage ; however , the eye will be fully formed , with normal eye pressure and no pupillary distortion .
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C |
D |
E |
A . Rust foreign body at 4 o ’ clock in the mid-periphery of the cornea .
B and C . Removal of the superficial part of the foreign body with a cotton tip .
D . Removal of the deeper part of the foreign body with the tip of a bevel-up 25G needle , scraping tangentially .
E . Appearance of stromal bed following complete removal of the rusted foreign body .
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Fluorescein staining will demonstrate |
the extent of the epithelial defect and confirm no aqueous leak |
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B |
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( Seidel negative ). |
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Patients with penetrating eye |
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injuries often have reduced vision |
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as the anterior chamber is shallower |
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and there is lower eye pressure |
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because of the aqueous leak . There |
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may be pupillary distortion from iris |
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incarceration or from direct trauma |
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and hyphaema . |
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It is often difficult to examine the |
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eye because of patient distress and |
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blepharospasm . There is risk of further |
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extrusion of the globe contents from the wound if there is excessively forceful opening of the eyelids . If the patient cannot co-operate , eye exam- |
Figure 4 . Slit lamp view of corneal abrasion from a banana leaf . |
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ination may not be possible .
Small penetrating eye injuries can be self-sealing , such as from palm fronds or small metal chips ( see figure 2 ). These may initially
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A . Faint epithelial mark just below the visual axis ( inside dotted ellipse ). |
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present with a fully formed anterior chamber and deteriorate three days later because of endophthalmitis .
Management
The management of non-penetrat-
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B . Fluorescein staining of the epithelial defect under cobalt blue light . |
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ing eye injuries is similar to that | ||||
of corneal abrasions ; however , | ||||
injuries may require more careful | ||||
follow-up because of the risk of keratitis | ||||
and scarring . | ||||
If a penetrating eye injury is | ||||
suspected , keep the patient calm | ||||
and quiet , with the eye covered by | ||||
a hard shield to avoid any pressure | ||||
on the eye . Keep the patient nil by | ||||
mouth in case emergency surgical | ||||
intervention is required . If emergency | ||||
transfer to ophthalmic care |
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in hospital is delayed , IV antibiotics ( vancomycin and ceftazidime ), analgesics , antiemetics and tetanus prophylaxis can be administered as indicated .
Prognosis
Significant indicators for a poorer prognosis include prolonged time from injury at initial presentation , poor visual acuity , damage to intraocular structures , and the presence of a relative afferent pupillary defect .
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Figure 5 . Fullthickness corneal laceration from a beer can ring-pull . The wound extends from 4 o ’ clock at the limbus to 7 o ’ clock across the peripheral cornea , demonstrating iris incarceration and distortion of the pupil and shallowing of the anterior chamber . |
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