Table 2.
Structure | Appearance and associated features | Implication |
---|---|---|
Lids | Lacerations of lid margins Puncture wounds Involvement of medial canthus |
Will require accurate repair Check for globe perforation Check for canalicular damage |
Conjunctiva | Sub-conjunctival haemorrhage | Usually harmless, but exclude perforation if the IOP is low |
Sclera | Grey or brown discolouration on sclera | Check for scleral perforation or laceration |
Cornea | Foreign body Abrasion Multiple staining areas following arc welding Laceration with iris prolapse |
Remove foreign body Treat with antibiotic and pad Treat as for an abrasion Will require urgent repair |
Anterior chamber | Blood in the anterior chamber – hyphaema | Usually resolves with conservative treatment; if secondary glaucoma, lower IOP with diamox |
Pupil | Peaked D shaped – Iris dialysis |
Check for laceration with iris prolapse, and refer for abcission repair Manage conservatively but watch for secondary glaucoma |
Lens | Iris tremor – probable lens dislocation White lens |
Usually requires removal Lens damaged resulting in a cataract |
Red reflex | No or poor red reflex | Possible vitreous haemorrhage |
Proptosis | Swollen lids and protruding eye | Medial wall blow out fracture with air in the orbit, orbital contusion or sub-periosteal haematoma |
Endophthalmos | Eye looks smaller – sunken-in globe | Inferior wall blow-out fracture |