Conjunctival Trauma

Conjunctival Trauma: Introduction & Types - Eye's First Shield

Conjunctival trauma involves injury to the conjunctiva, the eye's vital, transparent outer membrane. It acts as the first line of defense.

• Key Conjunctival Roles:
  • Protection: Shields underlying ocular structures from external insults.
  • Lubrication: Secretes mucin, contributing to tear film stability and ensuring smooth eyelid movement.
  • Immune Response: Contains Conjunctiva-Associated Lymphoid Tissue (CALT) for local immunity.
• Types of Conjunctival Trauma:
  • Mechanical: e.g., foreign body, abrasion, laceration.
  • Chemical: Caused by acids or alkalis (chemical burns).
  • Thermal: Burns from extreme heat or cold.
  • Radiation: Damage from UV light or ionizing radiation.

⭐ Conjunctiva's rich vascular supply leads to prominent subconjunctival hemorrhage but also facilitates rapid healing due to good blood flow.

Conjunctival Trauma: Mechanical Injuries - Scrapes, Tears, Bits

• Abrasions: Epithelial defect. Stains with fluorescein.
• Lacerations:
  • Superficial or deep.
  • Assess for scleral/corneal involvement.
  • Seidel test if perforation suspected.
  • Suture if > 1-1.5 cm or Tenon's capsule involved.
• Foreign Bodies (FB):
  • Superficial, embedded, or sub-tarsal (under eyelid).
  • Removal techniques vary; irrigation, cotton swab, or needle.
  • 📌 Double eversion crucial for superior fornix FBs.

  ⭐ Always perform double eversion of the upper eyelid to rule out foreign bodies lodged in the superior fornix, especially with linear corneal abrasions.

• Subconjunctival Hemorrhage:
  • Causes: Trauma, Valsalva, hypertension, idiopathic.
  • Appearance: Bright red blood under conjunctiva.
  • Management: Reassurance, artificial tears; resolves spontaneously.

Conjunctival Trauma: Chemical Burns - Splash Zone Peril

• Irrigate: Normal saline/Ringer's lactate, ~30 min or 2-3L until pH $7.0-7.4$.
• Grading: Roper-Hall/Dua (limbal ischemia > 180° = poor prognosis).
• Medical: Topical steroids, antibiotics, cycloplegics, oral Vit C 1-2g/day, lubricants, ?amniotic membrane.

⭐ The single most important step in managing chemical eye injury is immediate, copious, and prolonged irrigation.

Conjunctival Trauma: Thermal & Radiation - Heat & Zap

• Thermal Burns:
  • Causes: Flash, flame, contact (e.g., curling iron, hot liquids).
  • Features: Pain, conjunctival injection, chemosis, epithelial defects.
• UV Kerato-conjunctivitis (Welder's Arc, Snow Blindness):
  • Symptoms delayed: 6-12 hrs post-exposure.
  • Features: Severe bilateral pain, photophobia, foreign body sensation (FBS), diffuse punctate epithelial erosions.
  • 

  ⭐ Welder's arc flash (UV kerato-conjunctivitis) is characterized by a latent period of several hours (6-12 hrs) followed by intense bilateral eye pain, photophobia, and foreign body sensation.

• Radiation Injuries (Ionizing - Radiotherapy):
  • Delayed effects: Dry eye, keratinization, telangiectasia.
• General Management:
  • Lubrication (artificial tears), topical antibiotics.
  • Cycloplegics (for pain), NSAIDs (oral/topical).
  • Cool compresses; patching for comfort in UV burns (short-term).

Conjunctival Trauma: Complications & Management - Patch & Protect

• General Principles: Pain relief, infection prevention (topical antibiotics), promote healing, tetanus prophylaxis if indicated.
• Early Complications: Infection, persistent epithelial defect, corneal involvement.
• Key Complications & Management:

⭐ Symblepharon formation, an adhesion between palpebral and bulbar conjunctiva, is a dreaded complication of severe chemical burns and Stevens-Johnson syndrome, often requiring surgical intervention.

High‑Yield Points - ⚡ Biggest Takeaways

• Subconjunctival hemorrhage (SCH): Common, painless, resolves spontaneously; check BP if recurrent.
• Conjunctival lacerations: Assess for globe perforation (Seidel's); suture if >1 cm or gaping.
• Foreign bodies: Evert eyelids (especially superior fornix); remove with irrigation/swab.
• Chemical injuries: Immediate copious irrigation is critical; alkali burns are worse.
• Symblepharon: Late adhesion, a serious complication of severe trauma/burns.
• Always suspect deeper injuries: corneal abrasion, IOFB, ruptured globe.
• Chemosis (edema) is a common sign_