Approach to a Case of Ocular Blunt
Trauma
• Clinical Evaluation and Management
• Presented by: [Your Name]
• Date: [Insert Date]
Objectives
• - Understand mechanism of blunt ocular
trauma
• - Classify injuries by anatomical zones
• - Learn stepwise clinical approach
• - Review essential investigations
• - Outline management principles
Definition
• - Blunt trauma: Non-penetrating injury to
eye/adnexa
• - May involve globe, orbit, eyelids, lacrimal
system, or optic nerve
Common Causes
• - Assault
• - Road traffic accidents
• - Sports injuries (e.g., cricket ball)
• - Falls
• - Occupational hazards
Mechanism of Injury
• - Coup and contrecoup injuries
• - Compression/decompression forces
• - Shock wave transmission
Classification – BETTS
• - Closed globe: Contusion, lamellar laceration
• - Open globe: Rupture, laceration (rare in
blunt trauma)
• - Focus: Closed globe injuries
Ocular Zones Affected
• - Zone I: Cornea, limbus
• - Zone II: Anterior 5 mm sclera
• - Zone III: Posterior sclera
Initial Assessment (ATLS Principles)
• - Primary Survey: ABC
• - Secondary Survey: Ophthalmic focus
• - Rule out life-threatening injuries
Ocular History Taking
• - Time/mechanism of trauma
• - Object involved
• - Symptoms: pain, vision loss, floaters
• - Past ocular history
General Ocular Examination
• - Visual acuity
• - Pupil reactions (RAPD)
• - Eyelid/orbit trauma
• - Seidel test if globe rupture suspected
Anterior Segment Examination
• - Lids/conjunctiva: lacerations, hemorrhage
• - Cornea: abrasion, edema
• - AC: hyphema, depth
• - Iris/pupil: tears, iridodialysis
• - Lens: subluxation, cataract
Posterior Segment Examination
• - Media clarity
• - Fundus view or B-scan
• - Vitreous hemorrhage
• - Retinal detachment/tear
• - Choroidal rupture
• - Optic nerve damage
Investigations
• - Imaging: B-scan USG (if no rupture), CT orbit
• - Others: IOP (if safe), OCT, fundus photo
Hyphema – Specific Management
• - Bed rest, head elevation
• - Cycloplegics, topical steroids
• - Monitor IOP
• - Avoid NSAIDs
• - Surgical evacuation if needed
Traumatic Iritis
• - Pain, photophobia
• - Cells/flare, KPs
• - Tx: Cycloplegics, steroids
• - Monitor IOP
Lens Injuries
• - Vossius ring
• - Subluxation/dislocation
• - Rosette cataract
• - Tx: Depends on axis and IOL planning
Vitreous Hemorrhage
• - Sudden vision loss
• - Hazy fundus
• - Rule out retinal tear
• - Conservative/vitrectomy
Commotio Retinae
• - Retinal whitening
• - Usually resolves
• - Follow-up for CNV or macular hole
Retinal Detachment
• - Symptoms: Flashes, floaters, curtain
• - Urgent referral
• - Tx: Laser/surgery
Optic Nerve Injury
• - RAPD, poor vision
• - Normal fundus if indirect injury
• - CT/MRI
• - Steroids/decompression debated
Orbital Fractures
• - Blow-out signs: diplopia, enophthalmos,
numbness
• - CT orbit diagnostic
• - May need surgery
Follow-Up & Prognosis
• - Depends on extent
• - Monitor for complications: glaucoma, SO,
phthisis
Red Flag Signs
• - No light perception
• - Total hyphema
• - Suspected globe rupture
• - RAPD
• - Severe lid injury
Summary
• - Systematic evaluation needed
• - Imaging and referral critical
• - Multidisciplinary in polytrauma
• - Prognosis varies
References
• - Kanski’s Clinical Ophthalmology
• - AAO Trauma Section
• - Nema's Recent Advances
• - Peer-reviewed articles
