Trauma KMK

Questions and Answers

What is the most common cause of alkali burns?

Ammonium nitrate

Sodium chloride

Calcium hydroxide (correct)

Potassium carbonate

Which of the following is an indicator of ischemia in alkali burns?

Pupil dilation

Limbal blanching (correct)

Conjunctival injection

Corneal opacity

Which symptom is clearly associated with corneal abrasion?

Photophobia only

Dry eye syndrome

Foreign body sensation (correct)

Increased intraocular pressure

What sign would you expect to find in a case of corneal abrasion?

Corneal defect staining with fluorescein Signup and view all the answers

Which of the following signs is associated with conjunctival abrasion?

Subconjunctival heme Signup and view all the answers

What symptom is NOT typically associated with chemical ocular burns?

Nausea Signup and view all the answers

Which type of burn generally has a worse prognosis?

Alkali burns Signup and view all the answers

Which of the following is considered a common alkali agent?

Lye Signup and view all the answers

Which sign on examination indicates ischemia in severe chemical burns?

Scleral and limbal blanching Signup and view all the answers

What is the primary reason alkali burns are more common than acidic burns?

Greater accessibility to consumers Signup and view all the answers

Which of the following is NOT a sign of mild superficial punctate keratitis (SPK)?

Sloughing of the epithelium Signup and view all the answers

Which acidic agent is often found in rust removers and glass polishers?

Hydrofluoric acid Signup and view all the answers

Which symptom is least likely to result from chemical ocular burns?

Double vision Signup and view all the answers

What is most likely to occur if a hyphema obstructs the view of the fundus?

A B-scan is indicated Signup and view all the answers

Which type of hyphema fully fills the anterior chamber with blood?

8-ball hyphema Signup and view all the answers

What should a patient do to counter elevated intraocular pressure (IOP) due to blood accumulation?

Elevate their head to an optimal angle Signup and view all the answers

What condition can occur in approximately 5% of patients with late stage hyphema?

Corneal blood staining Signup and view all the answers

Which sign is associated with approximately 60% of hyphema cases?

Angle recession Signup and view all the answers

What is the most common type of orbital fracture?

Maxillary bone blow-out fracture Signup and view all the answers

Which symptoms are commonly associated with intraocular foreign bodies?

Decreased vision Signup and view all the answers

Which materials are considered inert when present as intraocular foreign bodies?

Glass and stone Signup and view all the answers

What is an important laboratory test to consider for idiopathic hyphemas?

Complete blood count (CBC) Signup and view all the answers

What should NOT be ordered in suspected cases of metallic intraocular foreign bodies?

Magnetic resonance imaging (MRI) Signup and view all the answers

Which condition significantly increases the risk of complications in idiopathic hyphemas?

Clotting diseases Signup and view all the answers

Which sign is NOT associated with orbital fractures?

Retinal detachment Signup and view all the answers

Which demographic should be particularly screened for sickle cell disease in cases of idiopathic hyphemas?

African American patients Signup and view all the answers

What is the most likely type of foreign body causing a rust ring in the cornea?

Metallic foreign body Signup and view all the answers

Which symptom is NOT associated with a ruptured globe or penetrating ocular injury?

Decreased vision Signup and view all the answers

Which sign is indicative of a positive Seidel's sign?

Dark stream of fluorescein dye Signup and view all the answers

What should NOT be performed within one month post-injury for a patient with hyphema?

Gonioscopy Signup and view all the answers

Which demographic is most susceptible to ruptured globe injuries?

Young to middle-aged males Signup and view all the answers

What is the primary contributing factor for a hyphema?

Blunt or penetrating trauma Signup and view all the answers

Which non-metallic foreign body is the least likely to cause a rust ring in the cornea?

Cilia Signup and view all the answers

What would you expect to observe in the anterior chamber of a patient with a ruptured globe?

Hyphema Signup and view all the answers

What is a primary characteristic of Purtscher’s retinopathy?

Diffuse retinal hemorrhages and cotton wool spots Signup and view all the answers

What percentage of blunt ocular trauma cases typically results in a choroidal rupture?

5-10% Signup and view all the answers

Which sign is indicative of eyelid ecchymosis?

Black eye resulting from trauma Signup and view all the answers

Which test is important to perform when a conjunctival or corneal laceration is suspected?

Seidel’s test Signup and view all the answers

What is a common risk associated with choroidal ruptures?

Development of choroidal neovascularization Signup and view all the answers

What does prolapsed orbital fat often cause?

Cosmetic concern and possible lid malposition Signup and view all the answers

Which of the following is NOT typically a cause of Purtscher’s-like retinopathy?

Glaucoma Signup and view all the answers

What is the prognosis for a corneal laceration that does NOT involve the visual axis?

Generally good with appropriate treatment Signup and view all the answers

What is a common consequence of an orbital wall fracture?

Damage to the infraorbital nerve Signup and view all the answers

What should be avoided in the first 48 hours after orbital trauma?

Blowing the nose Signup and view all the answers

What does a positive forced duction test indicate?

EOM restriction is present Signup and view all the answers

Which symptom is most likely to be associated with commotio retinae?

Acute vision loss if trauma occurs within the macula Signup and view all the answers

What distinctive feature indicates an iridodialysis?

A peripheral iris hole seen with retroillumination Signup and view all the answers

What is the Vossius ring associated with?

Contact with the pigmented iris epithelium Signup and view all the answers

What is a potential result of angle recession glaucoma following trauma?

Increased intraocular pressure Signup and view all the answers

What is an expected sign of commotio retinae?

Gray-white discoloration of the retina Signup and view all the answers

Study Notes

Chemical Burn

Epidemiology: Most chemical ocular burns (66%) occur in industrial settings, involving exposure to chemical or thermal agents.
Symptoms: Presentation includes normal or decreased vision, severe pain, foreign body sensation, photophobia, tearing, and blepharospasm.
Signs: Corneal damage ranges from mild superficial punctate keratitis (SPK) to complete epithelial sloughing. Other signs include conjunctival injection, chemosis, anterior chamber reactions, and scleral blanching indicating ischemia.
Pathophysiology: Alkali burns have worse outcomes than acidic due to elevated tissue pH and rapid penetration into cells. They are twice as common and are often more accessible.
Common Alkali Agents: Include ammonia, lye, magnesium hydroxide, lime, and airbag residue.
Common Acidic Agents: Include hydrofluoric acid, sulfuric acid, nitric acid, chromic acid, and PAVA spray.
Limbal Blanching: Indicative of ischemia, especially prevalent in alkali burns.

Corneal Abrasion

Epidemiology: Typically arises from trauma (e.g., fingernail, plant branch).
Symptoms: Patients report sharp pain (especially on blinking), foreign body sensation, photophobia, tearing, and blurred vision.
Signs: A corneal defect is observed with fluorescein staining, usually without underlying subepithelial infiltrate.

Conjunctival Abrasion

Epidemiology: Often caused by similar trauma as corneal abrasions.
Symptoms: Pain, foreign body sensation, and tearing are common.
Signs: May exhibit conjunctival injection or subconjunctival hemorrhage.

Hyphema

Epidemiology: Result of blunt or penetrating trauma; can also be idiopathic or linked to systemic diseases.
Pathophysiology: Trauma to the iris or ciliary body leads to bleeding in the anterior chamber. Avoid gonioscopy soon after injury to prevent rebleeding.
Symptoms: Include pain and blurred vision.
Signs: Presence of blood in the anterior chamber, which can vary in color and extent.

Corneal and Conjunctival Superficial Foreign Bodies

Epidemiology: Related to ocular trauma from foreign materials.
Symptoms: Patients experience foreign body sensation, tearing, redness, and photophobia.
Signs: Foreign bodies may be visible with or without surrounding sterile infiltrates. Rust rings can indicate metallic foreign bodies.

Ruptured Globe and Penetrating Ocular Injury

Epidemiology: More frequent in males, especially young and middle-aged.
Symptoms: Include pain, blurred vision, redness, photophobia, and tearing.
Signs: Indicative signs include full-thickness laceration, severe conjunctival hemorrhage, low intraocular pressure (IOP), and positive Seidel's sign.

Intraocular Foreign Body

Epidemiology: Typically due to trauma, particularly from high-speed impacts.
Symptoms: Pain and decreased vision are common complaints.
Signs: Imaging may reveal foreign bodies along with iris transillumination defects and other ocular injuries.

Orbital Fracture

Epidemiology: Often results from trauma from blunt objects.
Pathophysiology: Orbital floor fractures are the most prevalent due to the weakness of the maxillary bone.
Symptoms: Include pain and diplopia.
Signs: Vary by fracture site; can lead to visible subconjunctival hemorrhage and enophthalmos.

Commotio Retinae

Epidemiology: Associated with recent ocular trauma.
Pathophysiology: Results from disruption of retinal pigment epithelium and outer segments of photoreceptors.
Symptoms: Typically asymptomatic, but may cause acute vision loss if the macula is involved.
Signs: Gray-white discoloration of the retina; associated retinal hemorrhages may occur.

Iridodialysis

Caused by disinsertion of the iris root from the ciliary body; may pose a risk of angle-recession glaucoma.

Purtscher’s Retinopathy

Occurs often with chest compressing trauma and is characterized by retinal hemorrhages and cotton wool spots.

Choroidal Rupture

Occurs in 5-10% of blunt ocular trauma cases, presenting as a subretinal hemorrhage near the optic nerve with a risk of developing neovascularization.

Eyelid Ecchymosis

Also known as "black eye," results from trauma and can indicate underlying ocular damage.

Conjunctival and Corneal Lacerations

Tears in the corneal or conjunctival tissue following trauma; should undergo Seidel's test to check for open globe wounds.

Prolapsed Orbital Fat

Aging weakens the orbital septum, causing soft out-pouches of fat in eyelids that are generally asymptomatic but may lead to cosmetic issues.

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Description

Test your knowledge on the causes and symptoms of ocular burns and abrasions in this quiz. Assess your understanding of alkali burns, ischemia indicators, and the signs associated with corneal and conjunctival abrasions. Ideal for students in ophthalmology or medical-related fields.