Eye Injury
🔹 Epidemiology &
Importance
- ~55
ล้านราย/ปีทั่วโลก
- 27% → VA < 20/200 (legal
blindness)
- Early
ophthalmology →
improve outcome ~61%
👉 Key: ต้อง recognize และ refer เร็ว
🔹 Classification (จำเป็นต่อการ triage)
1. Open globe injury 🚨
(vision-threatening)
- Full-thickness
wound (cornea/sclera)
- Types:
- Rupture
(blunt)
- Laceration
± intraocular foreign body
2. Closed globe injury
- No
full-thickness wound
- Examples:
- Corneal
abrasion
- Hyphema
- Traumatic
iritis
- Lens
dislocation
- Vitreous
hemorrhage
- Retinal
injury (tear/detachment)
3. Periocular injury
- Eyelid,
orbit, lacrimal system
- Important:
may have associated globe injury
🔴 Vision-threatening
conditions (ต้อง identify ทันที)
1. Chemical burn 🚨
- Alkali
> acid (penetration ลึกกว่า)
- Symptoms:
pain, ↓vision,
photophobia
- Management:
- Immediate
irrigation (NS/water) →
until pH normal
- ห้าม delay
2. Orbital Compartment Syndrome (OCS) 🚨
- Cause:
retrobulbar hemorrhage →
↑pressure → ischemia
- Signs:
- ↓VA
- RAPD
- Proptosis
- “rock-hard
eyelid”
- Management:
👉 emergency lateral canthotomy + cantholysis
3. Open globe injury 🚨
Clues:
- Teardrop
pupil
- Extruded
tissue
- Very
low VA
- Seidel
sign +
❌ ห้ามทำ:
- Tonometry
- Eyelid
pressure
- Eye
drops (fluorescein/tetracaine)
- Remove
foreign body
4. Traumatic hyphema
- Blood
in anterior chamber
- Risk:
↑IOP, rebleeding
- Symptoms:
pain, photophobia, ↓vision
5. Vitreous hemorrhage
- Floaters
/ hazy vision
- Red
reflex absent
- ต้องหา cause →
retinal tear/detachment
6. Retinal injury (tear/detachment)
- Flashes
+ floaters + curtain vision
- Management:
urgent ophthalmology
7. Optic nerve injury
- ↓vision + RAPD
- ↓color vision (red
desaturation)
- CT
orbit needed
- ❌
steroid high-dose → no
clear benefit
🔹 Initial Approach (ER
mindset)
Step 1: Primary survey
- ABC
first (head injury, C-spine, airway)
Step 2: Identify vision-threatening condition
👉 ถ้ามี suspicion
open globe:
- Stop
exam immediately
- Shield
eye
- NPO
+ IV antibiotic
- Consult
ophthalmology
Step 3: Focused eye exam (ถ้า safe)
- Visual
acuity (most important)
- Pupillary
response (RAPD)
- Extraocular
movement
- Visual
field
- External
inspection
🔹 Common injuries (แต่ต้อง exclude severe ก่อน)
✔️ Corneal abrasion
- Pain
+ photophobia
- VA
usually normal
- Fluorescein
+
✔️ Corneal foreign body
- Foreign
body sensation
- ต้อง exclude penetrating injury
✔️ Eyelid laceration
👉 Refer ถ้า:
- Full
thickness
- Lid
margin involvement
- Fat
prolapse
- Canalicular
injury
✔️ Orbital fracture
- Diplopia
- ↓infraorbital sensation
- CT
orbit = gold standard
🔹 Key Red Flags (จำให้ขึ้นใจ)
- ↓Vision ทุกกรณี
= serious จนพิสูจน์ว่าไม่ใช่
- Pain
+ photophobia = corneal / anterior segment
- Flashes
+ floaters = retinal tear
- Proptosis
+ tense orbit = OCS
- Irregular
pupil = open globe
🔻 Clinical Pearls
- Eye
trauma → อย่าพลาด open globe
- VA
= vital sign ของตา
- OCS → delay = blindness ภายในชั่วโมง
- Chemical
burn → irrigate ก่อนคิด
- Trauma
+ floaters → suspect
retinal tear
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