Medical Forum WA 07/13 Subscriber Edition July 2013 | Page 39

CLINICAL UPDATE

Common eye injury refresher

It is important to recognise the signs and symptoms of severe, sight-threatening injuries and conditions. The history of the presenting complaint will point you in the right direction, for example, chemical injury or mechanism of injury( blunt or sharp). Here, we are reminded of some simple techniques to determine the severity of an eye injury using basic instruments and techniques – focusing on three signs that will hone your ophthalmic diagnostic skills.

By Dr Michael Wertheim, Ophthalmologist

Eye complaints and injuries account for up to 3 % of all emergency department visits. The bulk of these visits are due to trauma and include mild injuries such as corneal abrasions through to sight-threatening injuries, which include penetrating eye injuries, severe chemical injuries and retinal detachments.

Pain relief

Use topical anaesthetic drops( such as amethocaine, tetracaine or oxybupivacaine) as a screening tool. Does the pain subside with simple topical anaesthetic drops? If the answer is yes, then the pathology is superficial and would include flash burns, corneal abrasion, corneal ulcer, chemical injury or corneal laceration. If the pain does not subside with the topical anaesthetic then you must consider more serious, posterior eye pathologies such as iritis, acute glaucoma or orbital pathologies.

Pupil

What is the pupil shape? If the pupil is a teardrop shape( Figure 1) then you must consider a penetrating eye injury – the cause of the teardrop shaped pupil is the iris prolapsing out of a full thickness laceration. If the pupil has an irregular, flower-shaped pattern( Figure 2) then you must consider iritis – the cause of this distorted pupil is posterior synechiae, that is, adhesions of the iris to the lens during inflammation. A fixed dilated pupil would point you towards possible acute angle closure glaucoma.

Red Reflex

Using a direct ophthalmoscope, look for the red reflex in the injured eye. If the red reflex is dull then consider vitreous and / or retinal pathologies. The most common causes of a decreased reflex post trauma would be a vitreous haemorrhage and / or a retinal detachment.

Simple techniques in detecting severity of eye conditions in ED or GP practice can hasten the treatment and triage of patients.

Declaration: Perth Eye Centre P / L, managing the Eye Surgery Foundation, supports this clinical update through an independent educational grant to Medical Forum. Author – no competing interests.

� Figure 1: Penetrating eye injury

� Figure 2: Iritis with posterior synechiae.

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