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History
The severity of the blunt force can
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be an indicator of the extent of the | ||||
intraocular damage . The hyphaema | ||||
causes blurred vision because of | ||||
obstruction of the visual axis . Blood | ||||
in the anterior chamber is painless ; | ||||
however , it will become painful if it | ||||
results in high intraocular pressure . | ||||
Loss of vision , particularly if more | ||||
than expected from the hyphaema |
alone , can indicate collateral ocular damage including lens dislocation , retinal detachment , traumatic optic |
Figure 7 . Corneal burns . |
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neuropathy and / or globe rupture . Diplopia is an indicator of blowout fracture resulting in orbital content herniation . It is important to note the eye history , such as the previous level of vision , surgery , medications such as anticoagulants , and any bleeding diatheses or abnormalities such as sickle cell trait or disease . The latter is more common in patients of African descent .
Examination
Sit the patient upright and still for 30 minutes and then assess the level of
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A |
B |
A and B . A burn from shampoo containing salicylic acid . This has resulted in disruption of the corneal epithelium , conjunctival injection and eyelid swelling , with diffuse punctate staining on fluorescein staining and cobalt blue light . |
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vision . This allows the blood to settle in the anterior chamber and the pupillary axis to clear . The level of blood can then be measured from the 6 o ’ clock position at the limbus ( see figure 6 .) The pupil may be dilated from rupture of the iris sphincter muscle , a condition known as traumatic mydriasis , or irregular in shape from damage to the iris root , which is known as iridodialysis . Also assess for limitation of movement of the extraocular muscles and exclude significant facial and intracranial injury .
Management
Ensure the patient remains calm and quiet and cover the eye with a hard shield to avoid any pressure on
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C |
D |
C . Alkali / thermal burn to the left eye caused by hot radiator fluid . The image shows opacification of the cornea , swelling of the conjunctiva ( chemosis ) and burns to the eyelid skin .
D . Hydrochloric acid burn with opacification of the corneal epithelium , and a large epithelial defect with underlying clear corneal stroma .
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the eye . If the hyphaema involves |
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less than one-third of the anterior chamber , refer the patient for urgent ophthalmic assessment and man- |
days . The pupil is dilated to immobilise the iris and stabilise clots , and inflammation treated with topical |
being more severe . The severity of burns ranges from mild , such as irritation from shampoo ( see figure 7A ) |
UV exposure caused by inadequate eye protection , for example , during arc welding or from the reflection off |
Also exclude other life-threatening pathology such as respiratory burns in thermal injury . |
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agement . If the hyphaema is greater |
steroids . Elevated intraocular pres- |
to sight-threatening injuries ( see |
snow or water . Corneal burns pres- |
Following copious irrigation , |
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than one-third or if the patient is |
sure requires glaucoma medications . |
figure 7C ) and may involve the sur- |
ent with pain , blurred vision , the |
assess the level of vision . Signs of |
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less co-operative , arrange for hospital admission . Further ophthalmic assessment includes the level of vision , the presence of a relative |
Prognosis
Hyphaema usually resolves with conservative treatment ; however ,
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rounding eyelid tissues .
History
It is important to establish the time
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sensation of an FB and photophobia . Flash burns often cause bilateral eye pain , with these symptoms occurring 4-8 hours post-exposure . |
more severe burns include eyelid swelling , corneal opacity , total epithelial defect , limbal ischaemia and conjunctival blanching . These signs |
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afferent pupillary defect , tonometry , and damage to other intraocular and orbital structures . Investigations |
recurrent bleeding and high intraocular pressure may result in permanent vision loss . There is a lifelong |
of the incident , the nature of the burn , the involvement of one or both eyes and any immediate action that |
Management
It is critical to immediately irrigate
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require urgent referral for ophthalmic care in hospital . Less severe burns can be less urgently referred |
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such as ultrasound scans , CT or MRI |
increased risk of traumatic glaucoma |
was taken . If possible , ascertain the |
the eye ’ s fornices and eyelids before |
within 24 hours . Mild chemical and |
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may be undertaken to exclude globe |
in all patients , so an annual eye |
chemical name or the ingredients |
examination as each second can |
thermal burns , like flash burns , |
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rupture and orbital fracture . |
examination is required . |
of the substance . Most acids cause |
affect prognosis . With the patient |
are managed with supportive care , |
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Management includes limiting physical activity , sleeping with the head elevated at at least 30 °, and |
CORNEAL BURNS
CORNEAL burns are categorised into
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more superficial burns whereas alkalis and hydrofluoric acid can penetrate the cornea and cause |
supine , irrigate with saline or water for 20-30 minutes , with the simultaneous application of topical anaes- |
with topical antibiotics , topical steroids , lubricants , pupil dilation and oral analgesia . More severe |
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an eye shield , to encourage resorp- |
three types : chemical , thermal and |
intraocular damage . Thermal burns |
thetics , to ensure full ocular surface |
burns also require oral doxycycline |
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tion of the hyphaema and preven- |
flash burns . Chemical burns are fur- |
commonly result from flames , explo- |
irrigation . Litmus paper may be used |
and ascorbate to reduce the risk of |
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tion of recurrent bleeding . This is |
ther classified as either acid or alkali |
sions or splashing hot materials . |
in chemical burns to ensure the |
corneal melting and amniotic mem- |
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most important for the first three |
burns , with alkali burns typically |
Flash burns result from excessive |
corneal pH is between 7.0 and 7.2 . |
brane application . |