Ocular Trauma
in Primary Care
Kenneth Chan
Connect 2016 - Wellington
Low velocity projectile -
superficial foreign body
Organic/metallic/synthetic
Removal under topical
anaesthesia
Central foreign body -
referral
History of minor trauma with
partial recovery but
recurrent discomfort
especially overnight
Needs debridement + patch
+ long-term lubricating
ointment
May need corneal ablative
laser
High index of suspicion when
history suggest high-velocity
projectile
Distortion of normal anatomy,
irregular pupil, iris prolapse
Change in visual acuity may
be minimal
Timely intervention usually
leads to good outcome
Severe blunt trauma to the
eye can cause scleral
rupture without obvious
external wound
Deflated eye with severe
loss of vision and loss of
intraocular content
Poor prognosis in spite of
prompt surgical treatment
Thorough examination for
intraocular foreign body is
necessary if entrance wound
is detected
Orbital imaging needed if
poor view of posterior
segment
Urgent surgical intervention
High risk of endophthalmitis
Thorough examination for
intraocular foreign body is
necessary if entrance wound
is detected
CT orbit needed if poor view
of posterior segment
Urgent surgical intervention
High risk of endophthalmitis
Orbital floor and medial
orbital wall blowout fracture
Manifest double vision and
reduction in extra ocular
movement, may be minimal
CT orbit recommended if
there is any suspicion of
orbital fracture
‘White-eye entrapment’
Delayed presentation
Impairment in elevation only
clinical sign in spite of
significant orbital floor
blowout
Immediate, copious
irrigation (>2L+ Saline)
until pH neutralises
Intensive topical and
systemic anti-inflammatory
treatment
Oral doxycycline and
vitamin C
Thank you
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