0845hrs: Blunt Trauma (Andrew Kirker)
/Dr Kirker is one of the current Retina Fellows at UBC and talks about blunt ocular trauma.
Begins with case from past wk. 65 yo WF hit by golf ball directly to right eye. CF vision, no reverse APD (dilated prior night.) Aphakic, vitreous in AC, cyrstalline lens was in vitreous cavity. No break external tissue but certainly internal damage. This is blunt trauma.
Most common in young males due to more active. Some advancements with organized sports protection.
Complete exam; kids may need EUA to complete this. Key to document other eye too. Often future medicolegal so documentation for those reasons too.
Lens: cataract acute or chronic, contusion rosette, zonular loss - may need capsular tension ring for surgery.
Retinal tears: horizontal traction of globe leads to this usually at time of injury. Can get necrotic and stretch tears too. Traumatic RD more often young men. Retinal dialyses often caused by trauma and frequently not diagnosed til much later when macula comes off. Must follow patients til get a good scleral depressed exam.
Berlins Edema (commotio retinae) retinal contusion/concussion. Show histology too. Usually good prognosis for contusion.
Traumatic macular holes: acute post vit detachment or chronic from CME. Does better than age related maculer holes.
Retinal haemmhorage could be hiding a choroidal rupture. Rupture can lead to CNVM in future.
Optic nerve: direct or indirect trauma; pallor may take 3-4 weeks. Rarely, can avluse optic nerve but this is more common with open globe injuries.
Back to the initial case presentation. PPV and secondary IOL for future and happy ending we hope.