4. Bursting injuries
Hypotony IOP< 2mmHg
Often rupture at limbus or under extraocular muscle
insertions or at optic nerve insertion
Need to explore posteriorly in such cases
May need to disinsert/reinsert EOM during globe
repair
Dr Laurie Sullivan 2009
laurence.sullivan@gmail.com 4
6. Hyphaema
Usually due to blunt trauma
Iris bleeding: may be
Micro
Macro
Tears of the iris root (angle recession) may cause
glaucoma, acutely or later
Dr Laurie Sullivan 2009
laurence.sullivan@gmail.com 6
8. Hyphaema
Blood level in AC, may lead to increased IOP
High IOP with AC full of blood can cause blood-
staining of the cornea which may take years to clear
8
Dr Laurie Sullivan 2009
laurence.sullivan@gmail.com
9. Hyphaema management
Short term
Prevent secondary haemorrhage (day 3 or 4)
Rest (admit teenagers))
Atropine 1% BD
Topical steroids: Dexamethasone 1% or
prednisolone acetate 1% - QID to hourly
Control IOP: topical Brimonidine, Timolol,
Acetazolamide
Consider AC washout if IOP > 40mmHg for >4/7
(blood-staining)
?topical aminocaproic acid (antifibrinolytic agent)
Dr Laurie Sullivan 2009
laurence.sullivan@gmail.com 9
10. Hyphaema management
Long term
Need to perform
gonioscopy @ 1 month
postop, looking for
angle damage. If found,
need to follow annually
for ↑ IOP
10
Dr Laurie Sullivan 2009
laurence.sullivan@gmail.com
11. Penetrating / Perforating Injuries
Penetrating = into eyeball wall
Perforating = through eyeball wall
Penetrating laceration – options
no Rx, BSCL, glue (cyanoacrylate or fibrin glue),
suture
Perforating laceration
Without tissue loss
With tissue loss
Dr Laurie Sullivan 2009
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12. Perforating Injuries
Without tissue loss:
noRx, BSCL, glue, suture
With tissue loss
Glue +/- plastic drape
Patch graft – cornea, sclera, conjunctival flap
Iris prolapse may need excision if present for some
time due to risk of epithelial ingrowth into AC
12
Dr Laurie Sullivan 2009
laurence.sullivan@gmail.com
Slide
10
13. Intraocular Foreign Body (IOFB)
High velocity metal
(hammering metal-on-
metal)
Use CT or plain Xray
Dr Laurie Sullivan 2009
laurence.sullivan@gmail.com 13
Slide
17
14. Dr Laurie Sullivan 2008
Chemical Injury
Alkali (lime), acid, alcohol, other solvents
Alkali worse because of increased penetration into
corneal tissue
First Aid at site: Irrigation, irrigation, irrigation! 1-2L
of normal saline, tap water, soft drink, milk, beer, (?
urine?).
15. Dr Laurie Sullivan 2008
Chemical burns
A&E: Irrigation, irrigation, irrigation!
1-2L normal saline.
LA drops will help (Benoxinate or Amethocaine, or
Xylocaine 1%) Analgesia. Dilate pupil (for comfort:
Mydriacyl/Tropicamide, Homatropine they all have
red lids)
Check pH (7-8 OK)
16. Dr Laurie Sullivan 2008
Chemical burns
Slit lamp exam (LA) - extent of epithelial loss
(fluorescein stain).
Limbal involvement? (whitening=ischaemia)
Evert upper lid, remove particulate matter with
cotton bud, forceps.
Topical antibiotics, steroids,
Topical Citrate (10%) and Ascorbate (10%) (buffer
alkali and inhibit PMN proteinase enzymes, support
new collagen from keratocytes),
Antiglaucoma Rx
36. Suturing IOLs
Absent capsular support
Options
ACIOL – easy, ? Corneal endothelial cell loss
Scleral sutured PCIOL – difficult, long term suture
degradation and IOL dislocation, erosion
endophthalmitis
Iris sutured – difficult, long term suture degradation
and IOL dislocation
Iris claw IOL – difficult, long term IOL dislocation
Dr Laurie Sullivan 2009
laurence.sullivan@gmail.com 36
37. Suturing IOLs to sclera
Ciliary sulcus 1.5 mm behind limbus
Various techniques, common principles
Avoid anterior ciliary arteries
Bury knots (scleral flaps)
Endocapsular rings (Cionni) may be useful for partial
bag dislocation
37
Dr Laurie Sullivan 2009
laurence.sullivan@gmail.com
38. Alcon CZ70 IOL
Dr Laurie Sullivan 2009
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39. Alcon CZ70 IOL
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40. Dr Laurie Sullivan 2009
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The bent 25-gauge
needle is used to
‘‘catch’’ the CIF-4
needle as it is
passed from the
main wound into
the eye.
41. Suturing 4 haptic Akreos IOL to Sclera
41
Dr Laurie Sullivan 2009
laurence.sullivan@gmail.com
42. Cionni ring segment for capsular bag
dislocation
42
Dr Laurie Sullivan 2009
laurence.sullivan@gmail.com
43. Suturing IOL to Iris - McCannel
43
Dr Laurie Sullivan 2009
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44. Iris sutured IOL with McCannel suture
44
Dr Laurie Sullivan 2009
laurence.sullivan@gmail.com