Examination Methods

The incidence of ocular injuries remains high despite the increase in safety regulations in recent years, such as mandatory seat belts and protective eye-wear for persons operating high-speed rotary machinery. Therefore it is important that every general practitioner and health care staff member is able to recognize an ocular injury and provide initial treatment. The patient should then be referred to an ophthalmologist, who should be solely responsible for evaluation of the injury and definitive treatment. The following diagnostic options are available to determine the nature of the injury more precisely.

Patient history: Obtaining a thorough history will provide important information about the cause of the injury.

❖ Work with a hammer and chisel nearly always suggests an intraocular foreign body.

❖ Cutting and grinding work suggests corneal foreign bodies.

❖ Welding and flame cutting work suggests ultraviolet keratoconjunctivitis.

The examiner should always ascertain whether the patient has adequate tetanus immunization.

Inspection (gross morphologic examination): Ocular injuries frequently cause pain, photophobia, and blepharospasm. A few drops of topical anesthetic are recommended to allow the injured eye to be examined at rest with minimal pain to the patient. The cornea and conjunctiva are then examined for signs of trauma using a focused light, preferably one combined with a magnifying loupe (see Fig. 1.11 for examination technique). The eyelids may be everted to inspect the tarsal surface and conjunctival fornix. A foreign body can then be removed immediately.

Ophthalmoscopy: Examination with a focused light or ophthalmoscope will permit gross evaluation of deeper intraocular structures, such as whether a vitreous or retinal hemorrhage is present. A vitreous hemorrhage may be identified by the lack of red reflex on retroillumination. Care should be taken to avoid unnecessary manipulation of the eye in an obviously severe open-

globe injury (characterized by a soft globe, pupil displaced toward the penetration site, prolapsed iris, and intraocular bleeding in the anterior chamber and vitreous body). Such manipulation might otherwise cause further damage, such as extrusion of intraocular contents.

H To properly estimate the urgency of treating palpebral and ocular trauma, it is particularly important to differentiate between open-globe injuries and closed-globe injuries. Open-globe injuries have highest priority due to the risk of losing the eye.

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