Ординатура / Офтальмология / Английские материалы / Illustrated Tutorials in Ophthalmology Kanski, Bolton 2001
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Investigations of orbital floor blow-out fracture
Coronal CT scan |
Hess test |
• Right blow-out fracture with |
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Restriction of right upgaze and downgaze |
‘tear-drop’ sign |
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Secondary overaction of left eye |
Surgical treatment of blow-out fracture
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(a) Subciliary incision |
• Coronal CT scan following repair of |
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(b) Periosteum elevated and entrapped |
right blow-out fracture with synthetic |
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material |
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orbital contents freed |
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(c)Defect repaired with synthetic material
(d)Periosteum sutured
Medial wall blow-out fracture
Signs
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Periorbital subcutaneous emphysema |
Ophthalmoplegia - adduction and abduction |
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if medial rectus muscle is entrapped |
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Treatment
•Release of entrapped tissue
•Repair of bony defect
Anterior segment complications of blunt trauma
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Hyphaema |
Sphincter tear |
Iridodialysis |
Vossius ring |
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Cataract |
Lens subluxation |
Angle recession |
Rupture of globe |
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Posterior segment complications of blunt trauma
Commotio retinae |
Choroidal rupture and |
Avulsion of vitreous base |
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haemorrhage |
and retinal dialysis |
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Equatorial tears |
Macular hole |
Optic neuropathy |
Complications of penetrating trauma
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Flat anterior chamber |
Uveal prolapse |
Damage to lens and iris |
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Vitreous haemorrhage |
Tractional retinal detachment |
Endophthalmitis |
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Grading of severity of chemical injuries
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Grade I (excellent prognosis) |
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Clear cornea |
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Limbal ischaemia - nil |
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Grade II (good prognosis) |
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Grade III (guarded |
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Grade IV (very poor |
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prognosis) |
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prognosis) |
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Cornea hazy but visible |
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• No iris details |
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• Opaque cornea |
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iris details |
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Limbal ischaemia < 1/3 |
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• Limbal ischaemia - 1/3 to 1/2 |
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• Limbal ischaemia > 1/2 |
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Medical Treatment of Severe Injuries
1.Copious irrigation ( 15-30 min ) - to restore normal pH
2.Topical steroids ( first 7-10 days ) - to reduce inflammation
3.Topical and systemic ascorbic acid - to enhance collagen production
4.Topical citric acid - to inhibit neutrophil activity
5.Topical and systemic tetracycline - to inhibit collagenase and neutrophil activity
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