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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