Trauma of the EYE

Dr Nida Farida,SpM

Eyelid Trauma

1. Haematoma

Eyelid Trauma

Eyelid Laceration

Canalicular laceration

Orbital Fractures

1. Blow-out orbital fracture

Orbital Fracture

2. Blow out medial wall fracture

3. Roof Fracture

Orbital Fracture

4. Lateral Wall Fracture

Trauma to the Globe

Definition :
1. Closed Injury
2. Open Injury
3. Contusion
4. Rupture
5. Laceration
6. Lamelar laceration
7. Penetration
8.Perforation

Trauma to the Globe

Principles of Management
1. Initial assesment
History of the injury
Examination of both eye and orbits
Determination of the nature & extent of any lifethreatening problems
2. Special investigation
- CT : IOFB
- USG : IOFB,globe rupture,suprachoroidal
haemorrhage,RD
- ERG: optic nerve & retina

Blunt Trauma
Cornea :
1. Corneal abration

2. Acute corneal oedema

Blunt Trauma

3. Tears in Descement Membrane

Blunt Trauma

Hyphaema

Blunt Trauma
Anterior Uvea:
1. Pupil

2. Iridodialysis

Blunt Trauma
Lens :
1. Cataract (flower shaped_rosette)
2. Subluxation
3. Dislocation

Globe Rupture
Retina and Choroid
1. Commotio Retinae
2. Choroidal rupture
3. Retinal Break& Retnal Detacment

Blunt Trauma
Optic Nerve :
1. Optic Neuropathy:

Fundus: initialy normal

Treatment : unsatisfactory
2. Optic Nerve Avultion

Penetrating Corneal
Trauma
1. Small Shelving :

- often heal spontaneously

- bandage lens
2. Medium Size :

- usually require suturing

3. With Iris Involvement :

- iris abscission and suturing

4. With lens damage :

- suturing & lens removal

Blunt Trauma

Penetrating Scleral Trauma

1. Anterior :

- iris prolaps

- vitreous incarceration

2. Posterior :

- retinal break

Superficial Foreign Bodies

1. Subtarsal
2. Corneal

Intraocular Foreign Bodies

Technique of removal :
1. Magnet
2. Forceps

Siderosis

Definition :
- IOFB doposition of iron introcular epithelial
stucture : lens, ciliar body
Sign : radial iron deposits on anterior lens capsule
and reddish brown staining of the iris

Intraocular Foreign Bodies

Siderosis
Complications : secondary glaucoma

pigmentary retinopathy
ERG : progressive b wave

Enucleation
1. Primary : only for every severe injuries

no prospect of vision
2. Secondary : if the eye is severely and
irreversibly damages
unsightly,uncomfortable

Sympathetic Ophtalmitis
Definition :
- bilateral granulomatous panuveitis
- fellow eye : uveitis
Presentation : 65% after 2wk-3 mh

90% : first year

Sign :
-exciting eye : red,irritable
-Sympathizing : photophobic & irritable
- both eye : granulomaous anterior uveitis
- multifocal mid peripheral choroidal infiltrates

Sign :
- Exudative RD in severe cases
Sunset glow appearence as in VKH

Sympatetic Ophthalmitis
Treatment :
-enucleation
-topical : steroids & mydriatics
-Systemic : steroids ; ciclosporin or
azathioprine

Bacterial Endophtalmitis
8 % of penetrating trauma
Risk factor : delayed in primary repair
Signs : = post operative
Prophylactic : ciproflocaxin 2x750 mg
open global injury

TRAUMA
KIMIA

Basa
safonifikasi

Asam

Tingkat Keparahan :
Derajat 1: kornea jernih dan tidak ada iskemik
limbus (prognosis sangat baik)
Derajat 2: kornea berkabut dengan gambaran iris
yang masih terlihat dan terdapat kurang dari 1/3
iskemik limbus (prognosis baik)
Derajat 3: epitel kornea hilang total, stroma
berkabut dengan gambaran iris tidak jelas dan
sudah terdapat iskemik limbus (prognosis
kurang)
Derajat 4: kornea opak dan sudah terdapat iskemik
lebih dari limbus (prognosis sangat buruk)11t :

Penatalaksanaan
Emergensi :
Tetes anastesi topikal (pantocain)
Irigasi saline 15-30 menit (makin lama
makin baik),aliran konstan
Basa : 2000 ml (irigasi)
Jk ada test kertas lakmus
Eversi kelopak
Debridement kornea (kapas lidi)
Bebat tekan/ bandage lens

Medikamentosa

Derajat 1 dan 2 :
- topikal : 7 hari steroid,sikloplegik,antibiotik(profilaksis)

Derajat 3 dan 4 :
- topikal steroid 7-10 hari ganti NSAID
steroid IV (bila perlu)
- topikal Na askorbat 10% tiap 2 jam
sistemik 2000 mg
- sikloplegik : atrophin 2 % 2x sehari
- Tetrasiklin oral 2x100 mg
- antiglaukoma
- asam hyaluronik : reepitelisasi

Pembedahan
Transplantasi sel limbus
Graft membran amnion

Indikasi Rawat Inap

Tr Basa 1 mata : rawat
Tr Asam 2 mata : rawat

THANK YOU

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