S05.1
DESCRIPTION
An intact cornea and sclera, but severely contused eye. Foreign body on or embedded in the cornea of an intact eye.
DIAGNOSTIC CRITERIA
Signs depend on site affected and nature of non-penetrating trauma.
Corneal injury
- Contusion: hazy oedematous cornea.
- Foreign body embedded on/in cornea.
Iris injury
- Sphincter rupture: dilated or irregular pupil margin.
- Hyphaema: blood in the anterior chamber due to rupture of the blood vessels.
Lens injury
- Cataract: reduced red reflex.
Lens suspensory ligaments
- Subluxed or dislocated lens: abnormal lens position.
Retinal injury
- Blood vessel injury: blood in vitreous, blood on/in the retina.
- Retinal breaks and tears.
Choroidal injury
- Choroidal break: blood visible under the retina.
Optic disc
- Disc swelling or pallor.
MEDICINE TREATMENT
Corneal injury
A superficial corneal foreign body may be removed with a bud or hypodermic needle.
To anaesthetise the cornea for removal of foreign body:
- Topical anaesthetic:
- E.g. Amethocaine ophthalmic drops, instil 1 drop. Repeat every 15 minutes, if necessary.
To relieve discomfort caused by iris spasm:
- Cyclopentolate 0.5–1%, ophthalmic drops, 1 drop instilled immediately.
Until epithelialisation is complete:
- Chloramphenicol, ophthalmic ointment, applied 8 hourly for 5–10 days.
Iris injury
Sphincter rupture
Manage conservatively. Follow-up in four days to exclude hyphaema.
Hyphaema
Bed rest for five days.
Monitor for complications, i.e. increased intraocular pressure, corneal staining, secondary bleed.
- Atropine 1%, ophthalmic drops, instil one drop 12 hourly for 5 days.
PLUS
Topical steroid drops:
- Dexamethasone, ophthalmic drops, instil one drop 4 hourly for 5 days.
REFERRAL
- A deeply embedded or full thickness corneal foreign body.
- Hyphaema if unable to monitor for complications or if complications develop.
- Any eye with severe trauma and decreased visual acuity.
- Lens, retina and choroidal injuries – refer within 12 hours.