00:02
Welcome back.
00:03
This will be a
relatively brief stroll
through some
major traumatic injuries of the eye.
00:11
Just so that you can be
aware of some specifics
and think a little bit more
about the anatomy
and consequences related to
being blunt force
to getting blunt force trauma
of the eye.
00:28
So, part of this will be the cornea,
and some of this will be the orbit
or the bones around the eye.
00:35
The cornea
is as you will recall,
a stratified squamous
non-keratinizing epithelium
that sits over a stroma.
00:46
It is innervated.
00:48
And because it's an epithelium,
we can erode that.
00:52
We can erode off
layers of the epithelium.
00:55
And or we can completely
ulcerated.
00:57
So those are the major effects
that are going to happen
in this epithelium.
01:01
And this can be scraping
or any of a variety of injuries
of that nature.
01:06
So, we'll talk about
corneal abrasion and ulcers.
01:09
And just keep in mind
that epithelium
that you're seeing
on the right hand side.
01:13
So signs and symptoms associated
with corneal abrasion,
because there is some
innervation there.
01:17
It will be painful,
and there will be inflammation,
because we have eroded that area,
and we will induce a
conjunctivitis around that.
01:30
Because of inflammation,
the vessels are leaky,
and we'll get watery eyes.
01:36
The arrow there is actually
pointing to an area
where we have a
superficial erosion and abrasion,
where we have scraped off
two, or three, or four
layers of that
stratified squamous
non-keratinizing epithelium.
01:51
Because now we have
exposed some raw nerve
and in civil feel like
there's something in the eye.
01:56
It would feel very uncomfortable.
02:00
Because again,
of inflammation,
and the mediators that are made
during inflammation,
we will tend to have mydriasis,
will tend to have a more
dilated pupil,
and so that will tend
to give you photophobia.
02:11
And with the edema that's in the eye
as a result of the inflammation
will tend to have blurred vision.
02:17
So all these things
make sense,
once we have
an inflammatory response
to a superficial abrasion.
02:23
One of the best ways
to visualize
how much of the cornea
has been abraded by
particular contact or rubbing
is with the flourescein stain.
02:31
So, we'll take a
dilute fluorescein dye,
drop it in by eyedrops.
02:35
And then with a
blue fluorescent lamp,
you can actually see it,
visualized here
is this kind of yellow green area
where we have increased dye uptake?
And that shows
the kind of geography of
what portion of the cornea
has been abraded?
How do we treat this?
Well, we don't want that
to get infected.
02:55
We could have
as we will see
a superficial abrasion
turn into an ulceration
and maybe something worse.
03:03
So we'll put
topical antibiotics in there.
03:05
If there's anything
retained in the cornea,
as a result of the original trauma,
we will obviously remove that.
03:13
We can actually put on
a little contact lens.
03:14
So, it's like putting a band-aid,
but over your cornea.
03:19
It will make it feel better,
and will lessen the amount of risk,
in terms of secondary infection.
03:26
And because it hurts,
we'll give you oral analgesia.
03:29
So, that's kind of the
make sense
in terms of the basic therapy
for corneal abrasion.
03:35
An ulcer is deeper.
03:37
So, we have now gone
all the way through
all those layers
so that superficial squamous
non-keratinizing epithelium,
we're down to
basement membrane and stroma.
03:46
So there's going to be greater risk
for a variety of things.
03:49
And they're going
to be more symptoms
simply because
we have scraped away
more real estate.
03:54
So there will be that conjunctivitis
associated with the inflammation.
03:58
It will hurt like the dickens.
04:00
It is going to be
extremely painful.
04:03
The nervous innervation
of the cornea
is going to make it really
feel like there's something
definitely in the eye
of foreign body.
04:10
There will be a discharge.
Again, because of the inflammation.
04:15
There's increased
vascular permeability.
04:17
There'll be a lot more fluid
that's coming out.
04:22
Because of the edema,
there will be blurred vision.
04:24
And again,
there'll be photophobia.
04:27
Because of the inflammation,
we tend to get mydriasis.
04:30
So, we get dilation
of the pupil,
and there will be
sensitivity to light.
04:37
How can this happen?
So, trauma.
04:40
So, a superficial abrasion
with a secondary infection.
04:43
Bingo.
04:45
We're down now
into a deeper ulcer
that gets beyond
all the layers of the cornea.
04:52
Contact wearers
who aren't scrupulous
about taking their contacts out
on a regular basis,
and or cleaning
their contact lenses
can get bacterial
and fungal infections
that will over time
sit underneath the lens
and erode all the layers of the
stratified squamous epithelium.
05:13
Some viral infections
can do this
such as herpes simplex,
and the sicca syndrome,
the Sjogren syndrome, dry eyes
that are associated with
diminished lacrimation.
05:24
Remember that
autoimmune diseases.
05:26
That will actually
can lead to corneal drying.
05:29
And with more corneal drying,
there will be a
greater predisposition
to getting
corneal ulcerations.
05:35
Most important:
Once we have an ulcer is that
we give topical antibiotics,
and of course
we'll give analgesia
because
it hurts like the dickens.