Ординатура / Офтальмология / Учебные материалы / Clinical Diagnosis and Management of ocular trauma
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Eyelid Injuries and Reconstruction: An Update |
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347 |
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type rotational flap in moderate tissue loss can be |
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carried out (Fig. 5). For upper eyelid, the arc of the |
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circle is below the lateral canthus and for lower it is |
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above the canthus. For severe tissue or lid loss, |
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Mustarde type flaps or lid sharing procedures can be |
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used. |
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While attempting closure of small lid margin |
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lacerations, the wound has to be modified to avoid |
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Figs 54.3A and B: (A) First silk suture through the tarsal |
formation of lid notch. The entire vertical portion of |
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the tarsus has to be removed corresponding to the |
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plate is tied first. Second through the grey line. Third and |
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width of the deficit. The tarsal excision is carried out |
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fourth behind and in front of the lash lines. (B) Skin and |
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perpendicular to the lid margin. A “V” shaped defect |
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muscles closed in layers. |
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is converted into a pentagon shaped defect before |
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closure. |
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LEVATOR MUSCLE DEHISCENCE |
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In levator muscle disinsertion cases, the patient may |
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present with mild to moderate ptosis with or without |
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the presence of a laceration. If the orbital fat is seen |
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in the wound, the same signifies damage to the orbital |
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septum. Exploration is sought in such cases. The orbital |
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septum is identified, exposed and fully opened and |
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the levator aponeurosis is explored. Tears in the muscle |
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can be repaired with 6/0 polyglactin sutures. The |
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disinserted aponeurosis can be sutured to the tarsal |
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plate with 3 6/0 polypropylene sutures. Care should |
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Fig. 54.4: Tenzel rotation flap |
be taken to preserve the lid contour. All prolapsed |
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lacrimal gland tissue should be repositioned before |
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closure. There should be no ectropion or |
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lagophthalmos after closure is complete. |
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CANALICULAR LACERATIONS
•Commonly missed injuries.
•Look carefully for the severed edges.
Fig. 54.5: Technique for lateral canthotomy and lid closure
Evaluate lid tissue loss by trying to approximate the |
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cut edges of the margins and see if closure can be |
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achieved without tension. If this is possible, the marginal |
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defect has to be closed in layers separately, i.e. the anterior |
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and posterior lamellae (Figs 54.3A and B). |
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If there is tissue loss and the wound cannot be |
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closed without tension, a lateral cantholysis or |
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canthotomy (Fig. 54.4) in mild cases and a Tenzel |
Fig. 54.6: Canlicular repair with stent |
348 |
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Clinical Diagnosis and Management of Ocular Trauma |
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Fig. 54.7: Eyelid avulsion preoperative |
Fig. 54.9: Eyelid injury with zygoma fracture 4 |
Fig. 54.8: Eyelid injury with canalicular injury |
Fig. 54.10: Eyelid injury with zygoma fracture 7 |
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•Irrigation from the ipsilateral punctum with fluoroscein stained saline or injection of air may help identify the cut edge of the punctum.
•Authors prefer to use bicanalicular stents, left in place for 6 months for repair (Fig. 54.6).
•The surrounding lid margin and adventitia can be repaired as described earlier.
•In our opinion the pigtail probe should be avoided.
•Before repairing the canaliculi it is important to determine the presence of any canthal tendon avulsion.
•Repair of the posterior horn of the medial canthal tendon is necessary to maintain the lacrimal pump function.
•Approximation and suturing of the 2 cut edges of the tendon with 6/0 polypropylene is sufficient to maintain function.
•The tendon can also be sutured directly to the periosteum.
•If both are absent micro-plating can be considered.
•Care must be taken to avoid inadvertent damage to the lacrimal sac during repair.
Conclusion
Though eyelid trauma has myriad manifestations, general surgical principles are to be followed in repair. Repair is to be attempted once the general condition of the patient permits; meticulous cleaning of the injured area, maintenance of asepsis is essential. In most cases one can manage edge to edge apposition as the lids are fairly forgiving of minor tissue loss. However, in cases of major tissue loss or where there is concurrent injury to canaliculi or canthal tendons, plastic repair as outlined above will yield very satisfactory results in terms of function andcosmesis.
Bibliography
1.Color Atlas of Ophthalmic Plastic Surgery: A.G.Tyers, J.R.O.Collins.
2.Oculoplastic Surgery: William P Chen.
3.Ophthalmic Plastic and Reconstructive Surgery: Frank A Nesi, Richard D Lisman, Mark Levine.
C H A P T E R
55Prevention of Ocular Trauma
B Shukla, P Dutta (India)
Introduction
“Prevention is better than cure” is an often quoted phrase. It can not be over-emphasised in ocular trauma. However it has remained more of a precept than practice. In ocular trauma it can be seen from
Table 55.1.
However this scarcity on prevention can be defended in a way as primary prevention in ocular trauma is not easy and secondary prevention can be managed by early and efficient treatment which has been discussed in detail in most of the books. Primary prevention is a little difficult as it is basically a problem of children and young adults many of whom are bound to indulge in all types of sports, fight, fast driving, etc. Secondary prevention depends on availability of good hospitals and efficient doctors at a convenient distance and cost. Tertiary prevention is basically rehabilitative and ameliorative.
The subject of prevention of ocular trauma can be looked at by several ways. Mention has already be made about primary, secondary and tertiary prevention.5 It can also be considered from environmental point of view whether occurring during the profession, during sports, driving, in criminal assault, agricultural, in war or at home. The third way would be to avoid in specific risk groups and lastly educational and legislative. All these views are not mutually exclusive and combination is possible. We shall however deal the subject mainly from the environment point of view. It may also be stated that the subject of prevention
is linked to the epidemiology of ocular trauma in a given population or region. This is bound to alter from country to country and within a large country from one region to another. This study on one hand will give the magnitude of the problem and on the other hand it would help in deciding the priority areas of prevention. In one study on epidemiology on ocular trauma in Northern India the incidence of avoidable injuries is stated as 67%.6 Although it is believed that many eye injuries are preventable7 actual data for the same is scarce.
Occupational Injuries
In most of the Western studies work related or occupational eye injuries are very common.8-10 In a report from MP, India 40.7% injuries were work related including labourers, farmers, industrial and sedentary workers.11 In many factories the workers are at high risk of getting eye injuries. In many cases flying splinters and particles are a big hazard. Not only protective glasses should be provided but the machines should also be guarded from emitting particles. Ordinary glasses or goggles usually do not provide much protection and in some cases can cause damage after breaking.12 Toughened or laminated glasses are better. However polycarbonate lenses with variable central thickness depending on degree of safety required are considered very satisfactory.13 However, at many places
TABLE 55.1: Ocular trauma coverage in various books
No. |
Year |
Name of book |
Author |
Total pages On prevention |
% age |
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1. |
1972 |
System of Oph. Vol. 14, Injuries |
Duke-Elder S1 |
1350 |
0 |
0% |
2. |
1991 |
Eye Trauma |
Singhleton BJ et al2 |
410 |
3 |
0.7% |
3. |
2002 |
Ocular Trauma |
Kuhn F et al3 |
445 |
2 |
0.45% |
4. |
2005 |
Management of Ocular Trauma |
Shukla B et al4 |
324 |
5 |
1.5% |
350 |
Clinical Diagnosis and Management of Ocular Trauma |
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APPENDIX: RECOMMENDATIONS OF INDIAN INSTITUTE OF STANDARDS.16
Classification of hazards related to eye, face and ear protection equipment.
Hazards against which protection equipment for eyes, face and ear should be used are given in Table 1.
TABLE 1: Hazards against which protection equipment for eyes, face and ear should be used
Code No. |
Protection against hazard |
Typical Industrial operations |
of Hazard |
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H-1 |
Impact |
Clipping, caulking, sealing, grinding of metals. Stone dressing, turning |
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of case iron and non-ferrous metals, etc. |
H-2 |
Dust |
Sealing, grinding, handling of cement, clay, etc. |
H-3 |
Splashes from metals |
Babbiting, pouring of lead in joints, die casting, dipping in hot metals, |
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pouring of molten metals and foundry work |
H-4 |
Splashes of liquids |
Handling of acids, alkalis and other chemicals |
H-5 |
Irritating gases and vapours |
- |
H-6 |
Reflected light and glare |
Testing of lamps, sheet metal and lathe work |
H-7 |
Injurious radiant energy |
Oxy-acetylene welding and cutting furnace work; electric arc welding; |
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open hearth, bessemer and crucible steel making |
H-8 |
Noise |
- |
Selection of equipment for different hazards
Different types of eye, face and ear protection equipment should be selected keeping in view the hazards they can protect against. Guidance may be taken from the information given in Table 2.
TABLE 2: Selection of different types of eye, face and ear protection equipment keeping in view the hazards they can protect against
Code No. |
Brief description of |
Recommended against |
Remarks |
of equipment |
equipment |
hazard code number |
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E-1 |
Safety spectacles with side |
H-1, H-6 and H-7 |
Spectacles may be fitted with |
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shields, safety lenses mounted |
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clear, tinned, blue or welding |
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in spectacle-type frame |
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filter gas lenses. |
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E-2 |
Cup-type goggle. Two pieces |
H-1, H-3, H-6 and H-7 |
Goggle may be fitted with clear, |
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holding safety lenses and |
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tinted, blue or welding filter |
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connected across the nose, |
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glass lenses |
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and provided with head-band |
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or harness |
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E-3 |
Goggles |
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(a) With ventilation |
H-4 |
- |
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(b) Without ventilation |
H-4 and H-5 |
- |
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E-4 |
Dust goggles |
H-2 |
- |
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E-5 |
One piece eye protectors |
H-1, H-2, H-3, H-4, H-6 and H-7 |
Should be capable of being |
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(Monogoggles) |
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used over prescription glasses |
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E-6 |
Face shields |
H-1, H-3, H-4, H-6 and H-7 |
- |
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E-7 |
Wire mesh goggles |
H-3 |
- |
there is no quality control and the goggles or face masks are cumbersome to wear. In a study it was found that only 10% of those injured at work were wearing some kind of protective device.8 Wearing of safety devices is not strictly enforced at many places.
Recreational Injuries
Various types of sports and games are common causes of eye injuries. In Western countries boxing is a very common cause of eye injury.14 Damage is usually in
proportion to mass and velocity (E=1/2 mv2). Hence hard balls like cricket and hockey balls can cause severe injury. However in eye injuries the radius of curvature of a ball is also important as smaller balls can enter the orbit easily causing severe damage to eye ball like the squash or golf balls. On the contrary larger balls like basketball, volleyball and football are unlikely to cause severe injury unless they strike with great force. Various devices like pads, abdominal guards, wrist and elbow guards are now available to minimize sport injuries. Helmets by cricket players and hockey goal
Prevention of Ocular Trauma |
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351 |
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keepers are very useful devices to minimize eye injuries. |
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Proper education, awareness and |
strict |
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In some countries like India bow and arrow are |
enforcement of traffic rules can go a long way to |
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common games and many eyes are lost due to sharp |
prevent eye injuries. However as stated earlier |
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arrow injury. Gilli danda is another such game |
secondary prevention by early reporting and treatment |
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commonly played in rural areas. Children should be |
can also prevent a more severe damage. |
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advised and prevented from playing such dangerous |
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games. Even a passer-by can get hurt. |
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References |
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Travel Injuries |
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1. |
Duke-Elder S : System of Ophthalmology, vol. IVX, |
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Injuries Henry Kimpton, London 1972. |
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The quality and the width of roads are not increasing |
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2. |
Shingleton BJ, Hersh PS, Kenyon KR :Eye Trauma, Mosby |
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in proportion with the alarming increase in cars and |
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year Book, St.Louis 398-400. |
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two wheelers. In addition the fast life in cities and |
3. |
Ocular Trauma : Kuhn F, Pieramici DJ : Ocular Trauma, |
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indulgence in liquor and smoking are also factors |
4. |
Thieme Publication, New York, 2002;19-20. |
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contributing to increasing number of road accidents. |
Shukla B, Natarajan S : Management of Ocular Trauma, |
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CBS Publishers, New Delhi, 2005;317-21 |
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Use of cell phone while driving is not yet prohibited |
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5. |
Park K : Park’s Text Book of Preventive and Social |
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in many places which may also be a causative factor |
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Medicine, 14th Ed., Banarsidas Bhanot Publishers, |
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in road accidents. Wearing of seat belts and helmets |
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Jabalpur 1995, 6. |
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can minimize such injuries. In some places animals are |
6. |
Shukla, B : Epidemiology of Ocular Trauma, Jaypee |
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also freely roaming adding to disaster. Strict regulations |
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Brothers Medical Publishers, New Delhi, 2002;91. |
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should be enforced by the concerned authorities. |
7. |
Vinger PF : The eye in sports medicine. In : Duane TD, |
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Jaeger, EA, Edit.Clnical Ophthalmology, Vol. 5, Harper |
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and Row 1985. |
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Other Injuries |
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8. |
Schein OD, Hibberd PL, Shingleton BJ et al :The |
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spectrum and burden of ocular injury, Ophthalmology |
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Other eye injuries can occur during a difficult labour, |
9. |
1988;95:300-05. |
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criminal assault and in domestic setting. Adequate |
Glynn R, Seddon J, Berlin B : The incidence of eye |
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injuries in New England adults, Arch Ophthalmol, 1988; |
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precautions, education and legislation can minimize |
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106:785–89. |
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these injuries. Domestic or casual injuries are quite |
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10. |
Saari M, Parvi V : Occupational eye injuries in Finland, |
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common. |
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Acta Ophthalmol Suppl. 1984;161:17-28. |
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It has been seen that children are more at risk for |
11. |
Shukla, B : Epidemiology of Ocular Trauma, Jaypee |
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injuries hence they should never be given pointed toys |
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Brothers Medical Publishers, New Delhi 2002;33-34. |
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or any type of fire work. They should also be not left |
12. |
Keeney A, Fintelmann E, Renaldo D : Clinical |
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alone. In a recent report it was found that all injuries |
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mechanism of non industrial trauma, Am J Opthalmol |
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1972;74:662. |
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occurring in children below 16 years were unsuper- |
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13. |
Schein OD, Vinger PF : Epidemiology and Prevention, |
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vised.15 |
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In : Eye Trauma, Edit. Shingleton BJ, Hersh PS, Kenyon |
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Similarly though injuries decline with advance in |
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KR, Mosby Year Book, St. Louis 1991, Chapter 36, p. |
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age there is again a rise in the very old. They are more |
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399-401. |
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prone to fall due to weakness, walking difficulties or |
14. |
Giovinazzo VJ et al : The ocular complications of boxing, |
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poor sight. A one eyed person is also at great risk |
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Ophthalmology 1987;94:587-95. |
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because of restricted field of vision and needs special |
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15. Vats S, Murthy GVS, Chandra M et al :Epidemiological |
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protection. Those who have undergone previous eye |
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study of ocular traumain an urban slum population |
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in Delhi, India, Indian J Ophthalmol 2008:56:313– |
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surgeries like cataract, keratoplasty and radial |
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16. |
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keratotomy are at a greater risk as relatively minor |
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16. |
Shukla B, Dutta P. Prevention of ocular trauma. In : |
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injuries can cause rupture of the globe due to |
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Shukla B, Natarajan S Edit, Management of ocular |
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dehiscence at the operative site. |
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trauma, CBS Publishers, New Delhi 2005;320-21. |
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C H A P T E R
56Endophthalmitis Prevention
Strategies
John D Sheppard (USA)
Introduction
Perfected treatment strategies depend on a surgeon’s preferences and individual patient needs.
Infectious complications following routine cataract surgery are the most feared of all ophthalmic infections, due to the high expectations for cataract operations in the 21st century. Endophthalmitis complicates approximately one in every 1,000 cataract operations. With clear corneal incisions, this rate may be rising. Risk factors cited in the peer-reviewed literature include extracapsular surgery, intracapsular surgery, clear corneal incisions, diabetes mellitus, prolonged surgical time, previous or concurrent trabeculectomy, repeated instrument entry and exit, chronic blepharitis, chronic conjunctivitis, keratitis sicca, ocular surface disease, capsular rupture, vitreous prolapse, and vitrectomy surgery. The potential for this risk may rise to one in every 100 cases with vitreous loss. Although rapid diagnosis and expeditious surgical intervention can preserve excellent visual function in many patients with endophthalmitis, preventive measures are the cornerstone of any surgical management strategy.
New Concepts in
Endophthalmitis Treatment
The landmark Endophthalmitis Vitrectomy Study (EVS), conceived by Dr Bernard Doft and completed in 1995, found that 70% of endophthalmitis cases were caused by coagulase-negative, Gram-positive micrococci, overwhelmingly Staphylococcus epidermidis.1
This study has revolutionized our treatment algorithm for postcataract surgery endophthalmitis, recognizing the essential aspects of vitreous-tap diagnosis and expeditious injection of intravitreal antibiotics, while surprisingly raising the threshold for pars plana vitrectomy for patients with light perception or worse-quality vision.
New data have extended our understanding of the pathogenesis and prevention of postoperative endophthalmitis since the completion of the EVS. Postcataract infections originate by one of three routes:
(1) introduction through instrumentation at the time of surgery; (2) inoculation through the wound after cataract surgery; and (3) (although extremely rarely) by endogenous spread from concurrently infected extraocular tissues, such as a tooth abscess or infected diverticulum. Material presented at the 2002 ARVO meeting in Fort Lauderdale, Florida, in particular offered insight into bacteriologic factors relevant to cataract surgery.
Existing Literature
With experience and consideration of extensive laboratory data, most surgeons now believe that postcataract infections are introduced into the eye from the ocular surface. This belief brings into question the traditional use of topical perioperative aminoglycosides for cataract patients, especially when most endophthalmitides are Gram-positive and aminoglycosides are so insoluble. In our analysis, Gram-positive isolates from 163 patients with bacterial conjunctivitis were only 85% sensitive to tobramycin, while 97% were sensitive to levofloxacin, a third-generation fluoroquinolone, 83% to sulfasoxazole, 77% to ciprofloxacin, and only 75% to trimethoprim, commonly used in combination with the Gram-negative agent, polymyxin B.2
Franco Recchia of Vanderbilt University and colleagues clearly showed that an increasingly higher percentage of postcataract infections are due to Grampositive organisms.3 In a study of 493 consecutive patients with postcataract endophthalmitis, researchers cultured an organism from the vitreous in 318 cases (65%). During the last decade of the 20th century, grampositive isolates increased from 92 to 97%. Furthermore, resistance rates to commonly used prophylactic antibiotics increased; resistance among all isolates to
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Endophthalmitis Prevention Strategies |
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353 |
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ciprofloxacin rose significantly (23 to 38%), while |
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irrigating solutions during cataract surgery, a group of |
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resistance to ciprofloxacin and cefazolin rose among |
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researchers in Arizona, led by Robert Snyder, MD, do |
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coagulase-negative staphylococci (18 to 38%). |
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not see the efficacy of this approach.7 Dr Snyder and |
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In his new study from Stanford University, |
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his colleagues noted that antibiotics chosen for infusion |
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Christopher Ta and associates compared the ability of |
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should be fast-acting, due to the limited time exposure |
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21 different antibiotics to cover coagulase-negative |
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to purported intracameral bacterial contaminants. The |
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Staphylococcus organisms.4 Researchers took |
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fluoroquinolones showed dose-dependent killing. On |
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preoperative conjunctival swabs from 66 patients prior |
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the other hand, vancomycin killing did not correlate |
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to applying antibiotics or antiseptic. Their analysis |
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with drug concentration relative to the MIC of |
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concluded that, among the four fluoroquinolones |
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Staphylococcus species tested. Fluoroquinolones may |
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tested, levofloxacin had the highest antistaphylococcal |
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be more suitable for killing bacteria seeded into the |
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susceptibilty (91%) compared to norfloxacin (79%), |
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anterior chamber |
than vancomycin. Because |
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ofloxacin (75%), and ciprofloxacin (73%). Conversely, |
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vancomycin concentration decreases rapidly in the |
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resistance patterns also favored levofloxacin at only |
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anterior chamber following surgery completion, |
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5%, whereas norfloxacin was 18%, ciprofloxacin 20%, |
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residual surviving organisms with exposure to this |
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and ofloxacin 23%. |
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antibiotic of last resort could have a high likelihood |
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Practical Clinical Practice |
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of vancomycin resistance. Those who advocate |
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aminoglycoside antibiotic infusion during routine |
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surgery ignore both the severe potential retinal toxicity |
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Revealing in vivo data from Frank Bucci, MD, in |
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of this class, and waning Gram-positive sensitivity. |
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Wilkes-Barre, Pennsylvania, demonstrate that |
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levofloxacin |
reaches therapeutic |
aqueous |
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concentrations, therefore exceeding the mic90 for both |
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Microbial Antibiotic Resistance |
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Staphylococcus and Streptococcus.5 Dr Bucci found |
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that 0.5% levofloxacin reached fourto sevenfold |
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Careful clinical analysis customized to each prospective |
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higher aqueous concentrations than 0.3% ciprofloxacin |
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cataract patient by a knowledgeable, conscientious |
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when administered according to identical preoperative |
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surgeon provides the best solution to endophthalmitis |
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regimens. The ciprofloxacin levels were below the |
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risk. There is no single agent capable of killing every |
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established NCCLS MIC90 for both Staphylococcus |
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microbe known to cause postoperative infections.8 |
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and Streptococcus. Dr Bucci also noted that, higher |
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Even in this brief review of recent ARVO abstracts, |
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intracameral levofloxacin concentrations could be |
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epidemiologic patterns differ between hospitals, cities, |
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achieved with a regimen of administering five drops |
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and regions, a fact that renders each surgeon uniquely |
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every 10 minutes immediately prior to surgery, when |
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capable of understanding the peculiarities of their own |
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compared to administering the drug four times per |
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bacteriologic environs. Although newer fourth- |
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day for 2 days preoperatively. He achieved an |
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generation fluoroquinolones, such as moxifloxacin and |
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additional 50% increase in aqueous levels by combining |
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gatifloxacin, may demonstrate increased potency for |
|
||||||
the two regimens. |
|
|
|
|
||||
|
|
|
Gram-positive bacteria over secondand third- |
|
||||
Starr, Jensen and Fiscella6 |
showed that, of 24 |
|
|
|||||
|
generation drugs, the fourth-generations demonstrated |
|
||||||
endophthalmitis cases in 9,079 patients, eyes receiving |
|
|
||||||
|
no advantage for Gram-negative coverage in a keratitis |
|
||||||
topical ofloxacin postoperatively |
developed |
|
|
|||||
|
study conducted by Kowalski et al.9 Gram-negative |
|
||||||
endophthalmitis significantly less often than those |
|
|
||||||
|
resistance appears to cross all fluoroquinolone |
|
||||||
receiving topical ciprofloxacin (P<.0009). According |
|
|
||||||
|
generations. Thus, miniscule but significant holes have |
|
||||||
to these investigators, this difference in endophthalmitis |
|
|
||||||
|
appeared in the once-invincible fluoroquinolone |
|
||||||
rates may reflect differences in pharmacological and |
|
|
||||||
|
family’s Gram-negative coverage spectrum. The best |
|
||||||
bioavailability |
properties |
that exist among |
|
|
||||
|
protection of all may be a thorough povidone-iodine |
|
||||||
fluoroquinolone antibiotics. Ciprofloxacin, the least |
|
|
||||||
|
preparation,10 including the periorbital skin, lids, lashes, |
|
||||||
soluble of available topical fluoroquinolones, achieves |
|
|
||||||
the lowest intraocular levels. Levofloxacin, with 3.3 |
|
and conjunctival cul-de-sac. |
|
|||||
times more active drug per drop than ofloxacin, might |
|
Consistent routines, meticulous iodine preparation |
|
|||||
be the preferred choice at this time because of superior |
|
and reliable surgical technique, coupled with highly |
|
|||||
Gram-positive coverage and solubility. |
|
|
effective and penetrating topical antibiotics given |
|
||||
Even though some surgeons have popularized the |
|
frequently prior to surgery, provide our patients with |
|
|||||
use of antibiotic infusion through balanced saline- |
|
the best defense against infection. |
|
|||||
|
|
|
|
|
|
|
|
|
354 |
|
|
Clinical Diagnosis and Management of Ocular Trauma |
|||
|
References |
7. |
Snyder RW, Krueger T, Nix DE: Kill curves for vancomycin |
|||
|
|
|||||
|
|
|
|
|
||
|
|
|
|
|
|
versus 3rd generation quinolones. IOVS 2002 (abstr |
|
|
|
|
|
|
|
|
1. |
Han DP, Wisniewski SR, Wilson LA, et al: Spectrum and |
|
4452) (suppl). |
||
|
|
|
susceptibilities of microbiologic isolates in the |
8. |
Benz MS, Scott IU, Flynn HW, et al: In vitro susceptibilities |
|
|
|
|
Endophthalmitis Vitrectomy Study. Am J Ophthalmol |
|
to antimicrobials of pathogens isolated from the vitreous |
|
|
|
|
1998;122:1-17. |
|
|
cavity of patients with endophthalmitis. IOVS 2002 (abstr |
|
2. |
Sheppard JD, Oefinger PE, Wegerhoff PE: Susceptibility |
|
4428) (suppl). |
||
|
|
|
patterns of conjunctival isolates to newer and established |
9. |
Kowalski RP, Karenchak LM, Romanowski EG, et al: An |
|
|
|
|
anti-infective agents. IOVS 2002 (abstr 1588) (suppl). |
|
in vitro comparison of 2nd, 3rd, and 4th generation |
|
|
|
|
|
|||
|
3. |
Recchia FM, Busbee BG, Pearlman RB, et al: Changing |
|
fluoroquinolones against bacterial keratitis isolates. IOVS |
||
|
|
|
trends in the microbiologic aspects of post-cataract |
|
2002 (abstr 1585) (suppl). |
|
|
|
|
endophthalmitis. Arch Ophthalmol 2005;123:341-46. |
10. |
Ciulla TA, Starr MB, Masket S: Bacterial endophthalmitis |
|
|
4. |
Ta CN, Mino de Kaspar H, Chang RT, et al: Antibiotic |
|
prophylaxis for cataract surgery: an evidence-based |
||
|
|
|
susceptibility pattern of coagulase-negative staphylococci |
|
update. Ophthalmology 2002;109(1):13-24. |
|
|
|
|
in patients undergoing intraocular surgery. IOVS 2002 |
11. |
John D. Sheppard, MD, MMSc, serves as Professor of |
|
|
|
|
(abstr 4444) (suppl). |
|
Ophthalmology, Microbiology and Immunology, as well |
|
|
5. |
Bucci FA: An in vivo comparison of the ocular absorption |
|
as Program Director for Ophthalmology Residency |
||
|
|
|
of levofloxacin versus ciprofloxacin prior to |
|
Training at the Eastern Virginia Medical School in |
|
|
|
|
phacoemulsification. IOVS 2002 (abstr 1579) (suppl). |
|
Norfolk, Virginia. He is also Clinical Director of the |
|
|
6. |
Starr MB, Jensen MK, Fiscella RG: A retrospective study |
|
Thomas R. Lee Center for Ocular Pharmacology. Dr. |
||
|
|
|
of endophthalmitis rates comparing quinolone antibiotics, |
|
Sheppard may be reached at (757) 622-2200; |
|
|
|
|
Am J Ophthalmol 2005:140;769-71. |
|
docshep@hotmail.com |
|
|
|
|
|
|
|
|
Index
A
Abrasions of the globe 312
clinical signs and symptoms 312 differential diagnosis 312 investigations 312
prognosis 312 treatment 312
Acute postoperative endophthalmitis 174
intraocular antibiotics 175 aminoglycosides 175 ceftazidime 175 vancomycin 175
prophylaxis 174 steroid treatment 176
subconjunctival and topical antibiotic therapy 176
systemic antibiotics 176 vitrectomy 177
Algorithm for management of open globe injury 214
B
Bimanual vitrectomy 330 Birth trauma 68
Blunt eye trauma 80
Blunt injuries of the globe 312 clinical signs and symptoms 312 differential diagnosis 314 investigations 314
prognosis 314 treatment 314
Blunt retinal trauma 189
individual pathologies description 190
chorioretinitis sclopetaria 197 choroidal rupture 194 commotio retinae 190 purtscher retinopathy 198 traumatic macular hole 191 traumatic retinal detachment
193
traumatic retinal tears 192 vitreous base avulsion 194 vitreous hemorrhage 194
initial evaluation 190 mechanism of damage 189
Blunt trauma of anterior segment 67 Blunt trauma related retinal tears and
retinal detachments 149 Bottle cork injury to the eye 296
clinical features 297
prevention 298 treatment 298
C
Causes of postoperative nonimprovement of BCVA in traumatic cataract 75
Chandelier illumination 328 Chemical and thermal burns of the
eye 317
clinical signs and symptoms 318 differential diagnosis 318 investigations 318
prognosis 318 treatment 318
Chemical injuries of the eye 50 management 50
general principles 50
recent advances in therapy 52 pathogenesis 50
acids 50 alkalis 50 classification 50
Chorioretinitis sclopetaria 169 clinical features 169
etiology and pathogenesis 169 treatment and prognosis 169
Choroidal rupture 168 clinical features 168 diagnostic testing 169
etiology and pathogenesis 168 treatment and prognosis 169 Chronic postoperative endophthalmitis
177
bleb-associated endophthalmitis 178
post-traumatic endophthalmitis 178 Clinical evaluation of ocular trauma 10
general examination 10 structural examination 10
functional examination 11 ocular adnexa 10
Closed globe injuries 332 Commotio retinae 167
clinical features 167 diagnostic testing 167 etiology and pathology 167 treatment and prognosis 167
Complication and contusin after phakic IOLs 273
anterior chamber phakic IOLs 273 cataract formation 275
chronic inflammation and uveitis 274
glare and halos 274 glaucoma 275
induced astigmatism 274 pigment dispersion and lens
deposits 273 size-related complications
pupil ovalization and retraction 274
iris-fixated anterior chamber phakic intraocular lenses 275
cataract formation 276 chronic inflammation and
uveitis 276
complications of iris-supported phakic IOLs 275
endothelial cell loss and anterior chamber depth 276
glare and halos 276 glaucoma 276
pupil ovalization and decentration 276 posterior chamber phakic
intraocular lenses 277 Complications of corneal injury 46
astigmatism 48 corneal infection 46
iris/capsular incarceration 46 posterior segment complications 47 post-traumatic endophthalmitis 47 secondary glaucoma 46 sympathetic ophthalmia 47 traumatic cataract 46
Complications of SFIOL 97 choroidal detachment 98 cystoid macular edema 97 endophthalmitis 98 glaucoma 97
lens decentration and lens tilt 97 retinal detachment 97
suture erosion 98 uveitis 98
Conjunctival injuries 125 types 125
Corneal injuries 126 evaluation 126 Corneal laceration 279
complex corneal laceration wound 281
corneal laceration with tissue loss 281
356 |
|
|
|
|
|
|
|
|
Clinical Diagnosis and Management of Ocular Trauma |
|
|
|
|
|
|
|
|
|
|||||||||||||
|
injury assessment |
279 |
|
prognosis |
|
37 |
|
|
|
|
|
|
|
mortality/morbidity |
100 |
|
|
||||||||||||||
|
|
|
|
|
|
|
|
|
|
|
|
|
|||||||||||||||||||
|
|
medical management |
279 |
treatment |
|
37 |
|
|
|
|
|
|
|
pathophysiology |
100 |
|
|
|
|||||||||||||
|
|
perforating or nonperforating |
Hyphema |
68 |
|
|
|
|
|
|
|
|
treatment |
101 |
|
|
|
|
|
|
|
||||||||||
|
|
corneal laceration |
279 |
complications |
69 |
|
|
|
|
|
conservative treatment |
101 |
|||||||||||||||||||
|
|
simple corneal laceration |
280 |
ophthalmic examination |
68 |
|
holistic approach |
102 |
|
|
|||||||||||||||||||||
|
|
surgical management |
280 |
|
severity grades |
69 |
|
|
|
|
surgical care |
101 |
|
|
|
|
|||||||||||||||
|
|
use of tissue glue |
281 |
|
raised intraocular pressure |
69 |
Irreparable scleral rupture |
|
336 |
|
|||||||||||||||||||||
|
|
Corneoscleral laceration with lens and |
secondary hemorrhage |
69 |
|
|
|
|
|
|
|
|
|
|
|
||||||||||||||||
|
|
vitreous involvement 336 |
|
|
|
|
|
|
|
|
|
|
|
L |
|
|
|
|
|
|
|
|
|
||||||||
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|||||||||||
|
|
Corneoscleral laceration with tissue |
I |
|
|
|
|
|
|
|
|
|
|
Late post-traumatic glaucoma |
64 |
||||||||||||||||
|
|
loss |
336 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|||||||||||||||
|
|
|
|
|
Iatrogenic |
223 |
|
|
|
|
|
|
|
international incidence |
64 |
||||||||||||||||
|
|
Cultivated vs direct limbal |
|
|
|
|
|
|
|
|
|
||||||||||||||||||||
|
|
|
|
|
|
|
|
|
|
|
indian incidence |
|
65 |
|
|
||||||||||||||||
|
|
transplantation |
209 |
complications |
224 |
|
|
|
|
|
|
|
|||||||||||||||||||
|
|
|
|
|
|
slit lamp findings |
65 |
|
|
||||||||||||||||||||||
|
|
Cystoid macular edema 242 |
|
contraindications |
|
224 |
|
|
|
|
|
||||||||||||||||||||
|
|
|
|
|
|
|
gonioscopic findings 65 |
|
|||||||||||||||||||||||
|
|
clinical findings |
244 |
|
|
controlled release vehicles |
224 |
|
|||||||||||||||||||||||
|
|
|
|
pathology |
65 |
|
|
|
|
|
|
|
|||||||||||||||||||
|
|
etiology |
242 |
|
|
|
|
|
indications |
224 |
|
|
|
|
|
|
|
|
|
|
|
|
|
||||||||
|
|
|
|
|
|
|
|
|
|
|
|
|
Luxation and subluxation to the |
|
|||||||||||||||||
|
|
histopathology |
|
244 |
|
|
intravitreal injection |
224 |
|
|
|
||||||||||||||||||||
|
|
|
|
|
|
|
crystalline lens |
|
80 |
|
|
||||||||||||||||||||
|
|
treatment |
245 |
|
|
|
|
pulse therapy |
224 |
|
|
|
|
|
|
|
|||||||||||||||
|
|
|
|
|
|
|
|
|
|
clinical evaluation |
81 |
|
|
|
|||||||||||||||||
|
|
|
|
|
|
|
|
|
|
|
repository injection |
224 |
|
|
|
|
|
||||||||||||||
|
|
|
|
|
|
|
|
|
|
|
|
|
intracapsular extraction |
83 |
|
|
|||||||||||||||
|
|
E |
|
|
|
|
|
|
|
|
responsive diseases |
225 |
|
|
|
|
|||||||||||||||
|
|
|
|
|
|
|
|
|
|
|
|
IOL placement considerations |
84 |
||||||||||||||||||
|
|
|
|
|
|
|
|
|
|
anterior segment ischemia |
225 |
||||||||||||||||||||
|
|
Electrical injuries |
57 |
|
|
|
Boeck’s sarcoid uveitis |
225 |
phacoemulsification and IOL |
|
|||||||||||||||||||||
|
|
|
|
|
placement in subluxated |
||||||||||||||||||||||||||
|
|
clinical lesions |
|
57 |
|
|
|
herpes zoster |
|
225 |
|
|
|
||||||||||||||||||
|
|
|
|
|
|
|
|
|
|
crystalline lens |
|
83 |
|
|
|||||||||||||||||
|
|
lighting injury |
57 |
|
|
|
neoplasms |
225 |
|
|
|
|
|
|
|
||||||||||||||||
|
|
|
|
|
|
|
|
|
prognosis and long-term |
|
|
||||||||||||||||||||
|
|
Endogenous endophthalmitis |
179 |
ocular pemphigoid |
225 |
|
|
|
|||||||||||||||||||||||
|
|
|
considerations |
|
84 |
|
|
||||||||||||||||||||||||
|
|
Endophthalmitis prevention strategies |
orbital myositis |
225 |
|
|
|
|
|
||||||||||||||||||||||
|
|
|
|
surgical approach |
82 |
|
|
|
|
||||||||||||||||||||||
|
352 |
|
|
|
|
|
|
pseudotumor cerebri |
225 |
|
|
|
|
|
|||||||||||||||||
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
||||||||||||||
|
|
Evaluation of a patient with ocular |
Tolosa-Hunt syndrome |
225 |
M |
|
|
|
|
|
|
|
|
|
|||||||||||||||||
|
|
trauma |
|
13 |
|
|
|
toxoplasmosis |
225 |
|
|
|
|
|
|
|
|
|
|
|
|
||||||||||
|
|
approach in emergency 14 |
systemic therapy |
|
224 |
|
|
|
Management of a malpositioned |
328 |
|||||||||||||||||||||
|
|
examination |
15 |
|
|
topical application |
223 |
|
|
|
|||||||||||||||||||||
|
|
|
|
|
|
|
Management of acute corneal injury 41 |
||||||||||||||||||||||||
|
|
history |
|
14 |
|
|
|
|
Indications of SFIOL |
|
95 |
|
|
|
|||||||||||||||||
|
|
|
|
|
|
|
|
|
|
|
corneal laceration with tissue loss |
||||||||||||||||||||
|
|
approach to a patient with ocular |
Initial management of ocular trauma |
||||||||||||||||||||||||||||
|
|
43 |
|
|
|
|
|
|
|
|
|
||||||||||||||||||||
|
|
trauma |
|
14 |
|
|
|
|
patient |
20 |
|
|
|
|
|
|
|
|
|
|
|
|
|
||||||||
|
|
|
|
|
|
|
|
|
|
|
management of injury to lens |
44 |
|||||||||||||||||||
|
|
Eye injury prevention in children |
pearls |
20 |
|
|
|
|
|
|
|
|
|||||||||||||||||||
|
|
|
|
|
|
|
|
|
|
postoperative treatment |
45 |
|
|||||||||||||||||||
|
188 |
|
|
|
|
|
|
Injuries of the lids |
311 |
|
|
|
|
principles of repair |
43 |
|
|
|
|||||||||||||
|
|
Eyelid injuries |
|
345 |
|
|
|
|
clinical signs and symptoms |
311 |
slit-lamp biomicroscopy |
42 |
|
||||||||||||||||||
|
|
anatomy review |
345 |
|
|
differential diagnosis |
311 |
|
|
anesthesia |
43 |
|
|
|
|
|
|||||||||||||||
|
|
canalicular lacerations |
347 |
investigations |
311 |
|
|
|
|
anterior chamber |
42 |
|
|
||||||||||||||||||
|
|
classification |
345 |
|
|
|
prognosis |
|
312 |
|
|
|
|
|
|
conjunctiva |
42 |
|
|
|
|
|
|||||||||
|
|
examination |
345 |
|
|
|
treatment |
|
311 |
|
|
|
|
|
|
|
cornea |
|
42 |
|
|
|
|
|
|
|
|||||
|
|
levator muscle dehiscence |
347 |
Intraoperative floppy iris syndrome |
250 |
lens 42 |
|
|
|
|
|
|
|
|
|||||||||||||||||
|
|
lid margin repair |
346 |
|
|
Intravitreous triamcinolone associated |
sclera |
42 |
|
|
|
|
|
|
|
||||||||||||||||
|
|
management |
346 |
|
|
|
|
endophthalmitis |
179 |
|
traumatic wound dehiscence |
46 |
|||||||||||||||||||
|
|
|
|
|
|
|
|
|
|
|
IOFB 155 |
|
|
|
|
|
|
|
|
|
type of sutures |
45 |
|
|
|
|
|
||||
|
|
F |
|
|
|
|
|
|
|
|
clinical manifestations 155 |
|
|
viscoelastic materials |
|
44 |
|
|
|||||||||||||
|
|
|
|
|
|
|
|
|
|
localization |
156 |
|
|
|
|
|
|
Management of corneal injuries |
41 |
||||||||||||
|
|
Fugo’s plasma knife |
319 |
|
|
|
|
|
|
|
|
||||||||||||||||||||
|
|
|
|
management 156 |
|
|
|
|
|
classification |
41 |
|
|
|
|
|
|
||||||||||||||
|
|
key properties |
|
321 |
|
|
mode of injury |
|
155 |
|
|
|
|
terminology |
41 |
|
|
|
|
|
|
||||||||||
|
|
technique |
327 |
|
|
|
|
Iridodialysis |
102 |
|
|
|
|
|
|
|
Management of eyelid injuries |
28 |
|||||||||||||
|
|
|
|
|
|
|
|
|
|
|
causes |
102 |
|
|
|
|
|
|
|
evaluation of lid injury |
28 |
|
|
||||||||
|
|
G |
|
|
|
|
|
|
|
|
complications |
105 |
|
|
|
|
examination |
|
28 |
|
|
|
|
|
|||||||
|
|
|
|
|
|
|
|
|
|
principles of iris repair |
103 |
|
history |
|
28 |
|
|
|
|
|
|
|
|||||||||
|
|
Glued IOL |
132 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
||||||||||||||
|
|
|
|
|
|
|
iris implants |
103 |
|
|
|
principles of wound repair |
28 |
||||||||||||||||||
|
|
fibrin glue |
|
132 |
|
|
|
|
repair of iridodialysis 103 |
|
wounds associated with canthal |
||||||||||||||||||||
|
|
scleral fixated IOL |
132 |
|
suture placement |
103 |
|
|
tendon injuries |
31 |
|
|
|||||||||||||||||||
|
|
surgical technique |
132 |
|
suture tying |
103 |
|
|
|
wounds with no or minimal |
|||||||||||||||||||||
|
|
|
|
|
|
|
|
|
|
|
signs |
102 |
|
|
|
|
|
|
|
|
tissue loss |
29 |
|
|
|
||||||
|
|
H |
|
|
|
|
|
|
|
|
surgical planning |
|
102 |
|
|
|
wounds with significant tissue |
||||||||||||||
|
|
|
|
|
|
|
|
|
|
symptoms |
102 |
|
|
|
|
|
|
loss |
30 |
|
|
|
|
|
|
|
|||||
|
|
Hyphema |
35 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
||||||||
|
|
|
|
|
|
|
|
|
treatment and management |
102 |
Management of lacrimal injuries |
33 |
|||||||||||||||||||
|
|
associated exam findings |
36 |
Iris prolapse |
100 |
|
|
|
|
|
|
|
evaluation of lacrimal injuries |
33 |
|||||||||||||||||
|
|
examination |
35 |
|
|
|
clinical profile of a patient with |
examination |
|
33 |
|
|
|
|
|
||||||||||||||||
|
|
history |
35 |
|
|
|
|
|
|
|
|
iris prolapse |
100 |
|
|
history |
|
33 |
|
|
|
|
|
|
|
||||||
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|