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Transcript of ophthalmology presentation
and intraretinal and vitreous hemorrhage Three months later. The hemorrhages have cleared, revealing severe pigment epithelial necrosis. The visual acuity is counting fingers. Peripheral pseudoretinitis pigmentosa after blunt trauma, with marked bone spicule formation and atrophy of the nasal retinal blood vessels necrotic tears coup effect lead to full thickness necrosis
of retina with subsequent detachment An acute retinal detachment caused by a necrotic retinal break. power view of the necrotic break. Note the irregular edges. vitreous traction tears The avulsed vitreous base remains contiguous with the adjacent vitreous cortex. rapid equatorial expansion cause tear at ant,post, border of vitreous as it has no time for stretch
As a consequence, there is strong traction at the vitreous base that may cause tears at its anterior and posterior borders.
Tears along the anterior and posterior margins of the vitreous base are most common inferotemporally. strech retina An inferonasal stretch tear. Several retinal blood vessels have also been avulsed A full-thickness macular stretch tear and choroidal rupture. The inferotemporal retinal artery is avulsed. One month later, glial tissue has sealed the tear. (Courtesy of William H. Annesley, Jr, M.D.) Bed Rest Although the eye is well protected by the orbit, it may be subject to injuries Effect Blunt
trauma Dividing represent Blunt trauma............ 73% 27% 44.1% 14.7% 15.6% Mechanism Contrecoup refers to injuries at the opposite side of the eye caused by shock waves that traverse the eye coup&contrecoup Coup refers to local trauma at the site of impact shock waves antro-posterior compression lateral expasion mechanisms anterior segment orbit& eye lid fracture
carotid cavernous fistula
wound ( vertical,horozontal posterior segment Wide range of the ocualr trauma can occur concomitant with orbital fracture. Mechanism End finally by different types of bone fracture fracture of the lower orbit enophthalmos proptosis pulsating&non pulsationg
retro-pulbar hemorrage emphysema fracture of the right medial orbital wall orbital (white arrow), herniation of orbital fat through the fracture (black arrow), and orbital emphysema (arrowheads) When air for the air sinus oculocardiac reflex it is inhibition of heart beat induced by pressure of the eye ball nerve connections between the trigeminal cranial nerve and the vagus nerve black eye ptosis abnormally low position of the upper eyelid cutting of the levator palpebrae 3rd nerve affection .or mechanical ptosisdue to oedema or hemorrhage Orbit eyelid subconjuctival hge small, fragile blood vessels that are easily ruptured or broken mild pain or a scratchy patient complainment laceration chemosis leaks into the space between the conjunctiva and sclera. conjuctiova Ulcer Laceration Abrasion cornea sclera more common at at the limbus (under intact conjunctiva) and parallel to the muscle insertions rupture globe After blunt trauma, an eye has a hyphema, Subconjunctival edema signals a ruptured globe. ruptured globe demonstrates severe subconjunctival edema and a collapsed globe. Sclera Hyphema Blood in the anterior chamber + IOP blood staining of the cornea PAS complete bed rest&hospitalization patching the injuried eye matter of disscusion
to give advantege of reporting lowering vision
cover the eye with shield TTT When the lens is struck by the cornea or by a strong shock wave, a transient anterior subcapsular cataract anterior subcaspsular rosette cataract Lens choroidal injuries hemorrage choroidal ruptures are probably caused by anterior-posterior compression and equatorial expansion. rupture Choroidal rupture concentric to the optic disc Multiple choroidal ruptures. The visual acuity is 20/20. Large subretinal hemorrhage from a choroidal rupture under the fovea. Multiple subretinal hemorrhages choroid visual acuity Retina 1- cystoid macular oedema 2- acute post vitreous detachement
with foveal traction caused by contrecoup action full-thickness macular hole caused
by the contrecoup effect . The same eye shows inferior pigment necrosis
and proliferation caused by the coup effect. Anterior chamber&lens eyelid laciration the lower eyelid is everted due to contracture Effect on the eye commotio retinae retinal contusion caused by contrecoup injury centrally peripherally visual acuity affection varies with good prognosis except in choroidal rupture Macular hole eye shows inferior pigment necrosis and proliferation caused by the coup effect. Occasionally, rapid horizontal expansion of the eye can produce a stretch tear of the retina BVs crossing
tear Retinal&vitreous hge rupture of
ciliary body PVD retinal detachment 3/4 population are men
87%due to blunt trauma A typical traumatic retinal detachment. There is an inferotemporal retinal dialysis, a demarcation line, and no signs of proliferative vitreoretinopathy.