Eyeworld

24 October 2018 EW NEWS & OPINION by Liz Hillman EyeWorld Senior Staff Writer them can cause further damage and scarring of the corneal stroma. He added that these foreign bodies will often migrate more anteriorly over time making them safer to remove. Non-penetrating trauma can cause damage to seven rings of intraocular tissues resulting in iris sphincter tears and traumatic mydri- asis, iridodialysis, angle recession, cyclodialysis, trabecular meshwork tears, zonular rupture, and retinal dialysis. Non-penetrating trauma can also cause damage to the lens (contusion cataract, capsule rupture, and lens involution, to name a few) and hyphema. James Karesh, MD, Krieger Eye Institute, Baltimore, discussed chem- ical injury. "If you don't do some- thing about it right now, you've missed the boat," he said, explaining that eyes exposed to a chemical in- jury need to be flushed immediately onsite before bringing the patient to a more formal medical setting. An eye exposed to acid or alkaline might need to be irrigated for up to 2 hours to ensure all the chemical is removed. In addition, the person's clothes, if exposed, should be taken off and their face and body washed as well. The medic helping this per- son should take measures to protect their own eyes. Alkaline chemical injuries are the worst, Dr. Karesh said, explain- ing that ammonia is the worst of the worst, eating through the cornea and causing ciliary body damage. Acids might not be as bad as alkaline solutions because they create their own barrier to deep penetration. Dr. Karesh called hydrochloric acid the worst in this category due to its pro- pensity to cause systemic injuries. After copious irrigation, Dr. Karesh said treatment can include anti-inflammatory agents, anterior chamber washout, symblepharon rings, autologous serum, and umbil- ical cord serum. Surgical treatments, depending on the case, can include stem cell transplants, a keratopros- thesis, penetrating keratoplasty or lamellar keratoplasty, or a graft. In addition to training the next generation of military ophthal- mologists and staff physicians in units that could soon deploy, and thus could be facing these injuries sooner than others, Dr. Colyer sees the course as an opportunity to test Annual program focuses on injuries physicians may see when treating service members T hirty-six residents (some military and some local civilian), four military staff physicians in potentially deployable units, and 60 faculty members gathered for the 33rd Triservice Ocular Trauma Skills Laboratory at Uniformed Services University (USU) in Bethesda, Mary- land, a 4-day, annual program that prepares physicians for the types of injuries they might see in our nation's service members, both at home and abroad. "In my mind, this is the only course like it that exists," said Army Lieutenant Colonel Marcus Colyer, MD, director of the ocular trauma course at the Uniformed Services University of the Health Sciences, and a vitreoretinal surgeon at Walter Reed National Military Medical Cen- ter, Bethesda, Maryland. "It's tied to the expectation that the military has to treat wounded service members," he continued, noting that he and the other faculty are trying to tie all readiness aspects to this course. Attendees of the workshop, which took place in May, received lectures and intensive wet lab training in oculoplastics, anterior and posterior segment injury, ocular pathology, and advanced anterior segment surgical maneuvers. Dr. Colyer, who has been part of the course since 2005, led the way from room to room where attendees were working on everything from penetrating trauma and suture basics to simple laceration repair to more advanced suture techniques and laceration management. Each hands-on block surgical experience began with a 20- to 30-minute crash course lecture, aimed to give the attendee the most important synopsis related to the di- agnosis and management of injuries they might see in the field and how to handle them surgically. If a corneal foreign body ap- pears superficial in a blunt trauma case it should be removed said, Won Kim, MD, Walter Reed National Military Medical Center, but deeply embedded foreign bodies should be left alone as attempts to remove Reporting from the 33rd Triservice Ocular Trauma Skills Laboratory continued on page 26 Residents work on suture skills during a wet lab at the Ocular Trauma Workshop. A pig eye with blue dye to track damage is placed in a 3-D printed eye socket and exposed to a "pure blast" in an effort to simulate blast trauma on the eye. The eye is examined post-blast and shows no obvious signs of injury, but Dr. Rex notes that research is ongoing on the effect of such a blast on retinal structures and the optic nerve. Source (all): EyeWorld

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