Anda di halaman 1dari 62

FKK UMJ sri fulina 2012 1

KEDARURATAN PADA
TRAUMA OKULER
Sri Fulina W- RSHJ Sri Fulina W- RSHJ
FKK UMJ sri fulina 2011 2

Pendahuluan.
Trauma mata sering merupakan penyebab
kebutaan unilateral pada anak dan dewasa
muda. Kecelakaan dirumah, kekerasan,
ledakan aki, cedera akibat olahraga dan
kecelakaan lalu lintas merupakan keadaan
yang paling sering menyebabkan trauma
mata.
Sri Fulina W- RSHJ Sri Fulina W- RSHJ
FKK UMJ 3
Tujuan

- Kualitas hidup adalah Utama
- Mencegah komplikasi -
gangguan fungsi penglihatan.
- Fungsi penglihatan menurun--
kesempatan berkarier berkurang.
Sri Fulina W- RSHJ Sri Fulina W- RSHJ
FKK UMJ 4
Bolamata dilindungi oleh :
tulang orbita,palpebra,bulumata dan
lemak pd dinding bolamata.
Sri Fulina W- RSHJ Sri Fulina W- RSHJ
5
Eye Anatomy
Sclera
Choroid
Retina
Cornea
Iris
Pupil
Lens
Sri Fulina W- RSHJ Sri Fulina W- RSHJ
FKK UMJ 6
Klasifikasi menurut Birmingham
Eye injury :
Closed globe Open globe
- Contusion - Rupture
- Lamellar - Laceration :
Laceration * Penetrating
*IOFB
*Perforating
Sri Fulina W- RSHJ Sri Fulina W- RSHJ
FKK UMJ 7
Types of injury :
- Extrocular foreign body
- Chemical injuries and burns
- Blunt injury ( contusions )
- Penetrating and perforating injury
- Perforating injury with retained
foreign body
Sri Fulina W- RSHJ Sri Fulina W- RSHJ
FKK UMJ 8
PEMERIKSAAN AWAL PD TRAUMA
OKULER :
Anamnesis :
- Perkiraan ketajaman penglihatan sebelum
dan sesudah trauma.
- Apakah gangguan penglihatan bersifat
progressif,lambat atau mendadak.
- Harus dicurigai adanya benda asing (IOFB)
intraokuler bl ada rwyt memalu,asah atau
ledakan

Sri Fulina W- RSHJ Sri Fulina W- RSHJ
FKK UMJ 9
Pemeriksaan Fisik :
- Visus : bl ggn penglihatan parah periksa
proyeksi cahaya dan defek pupil aferen.
- periksa motilitas mata dan sensasi kulit
periorbita dan lakukan palpasi pd bgn tepi
tulang orbita.
- adanya enoftalmos dpt ditentukan dgn
melihat profil kornea dari atas alis.
- pemeriksaan memakai senter dn loupe.
Sri Fulina W- RSHJ Sri Fulina W- RSHJ
FKK UMJ sri fulina 2011 10
Pemeriksaan segmen anterior
bolamata:
Palpebra: periksa permukaan tarsal
Konyungtiva bulbaris: perdrhn,laserasi
Sklera: luka tertutup oleh perdrhn subkonyungtiva.
Kornea: korpus alienum,aberasi,laserasi
BMD: dalam (dislokasi lensa,luksasi ) ,dalam
(dislokasi lensa ke anterior )
Iris: iridodilisis,irdodenesis
Pupil: ukuran,bentuk &refeks chy,defek pupil aferen
pd mata yg cedera.
Sri Fulina W- RSHJ Sri Fulina W- RSHJ
Sri Fulina W- RSHJ Sri Fulina W- RSHJ
FKK UMJ 12
Pemeriksaan tekanan bolamata
Palpasi
Tonometer Schiotz :
- TIO rendah-
trauma penetrasi,ruptur,ablasi retina.
- TIO tinggi inflamasi,perdarahan.
Sri Fulina W- RSHJ Sri Fulina W- RSHJ
FKK UMJ 13
Pemeriksaan Penunjang:
Slit-Lamp
X-ray ant/post root.
CT Scan : mata ,orbita,tulang sekitarnya.
USG / B scan : intraokuler u/ deteksi
korpus alienum.
Indirect ophthalmoscopy.
Sri Fulina W- RSHJ Sri Fulina W- RSHJ
FKK UMJ 14
Extraocular foreign bodies
Etiologi:
partikel kecil,debu,batu halus,sayap
serangga dll.
Symptoms:
mata kelilipan,refleks blinking,iritasi
lakrimasi,fotofobia.
Sri Fulina W- RSHJ Sri Fulina W- RSHJ
FKK UMJ 15
Signs:
-refleks blefarospasme
-bd.asing bs pada konyungtiva bulbar,limbus
forniks dan kornea.
-bs singel / multiple.
Komplikasi :
- konjungtivitis disertai infeksi sekunder
- ulkus kornea akbt erosi pd kornea
- bl bd.asing tajam bs masuk kedlm bmd.
Sri Fulina W- RSHJ Sri Fulina W- RSHJ
FKK UMJ 16
Terapi :
- jangan menggosok-gosok mata
- cuci dgn air bersih
- anestesi lokal,angkat dgn memakai
jarum suntik/ cotton bud.
Sri Fulina W- RSHJ Sri Fulina W- RSHJ
FKK UMJ 17
Sri Fulina W- RSHJ Sri Fulina W- RSHJ
FKK UMJ 18
Subtarsal Foreign Body
Sri Fulina W- RSHJ Sri Fulina W- RSHJ
FKK UMJ sri fulina 2011 19
Particle in corner of eye
Sri Fulina W- RSHJ Sri Fulina W- RSHJ
FKK UMJ 20
Corpus Alienum
Sri Fulina W- RSHJ Sri Fulina W- RSHJ
FKK UMJ 21
Particle under lower eye lid
Pull the lower lid out by
depressing the skin above
the cheekbone.
Touch the particle with a
moistened cotton swab.
If that does not work, try
pouring water on the speck
while pulling the lower lid
out.

Sri Fulina W- RSHJ Sri Fulina W- RSHJ
FKK UMJ 22
Treatment for a particle under the upper
eye lid:

If the particle cannot be seen,
it's probably under the upper
lid, the most common hiding
place.
Try to open and close the eye
several times while it is
submerged in a pan or bowl of
water.
If this fails, pull the upper lid
out and draw it over the lower
lid. This maneuver and tears
will sometimes dislodge the
particle

Sri Fulina W- RSHJ Sri Fulina W- RSHJ
FKK UMJ 23
Chemical injuries and burns
Etiologi:
-burn injuries :air panas,debu panas,
bubuk eksplosif.
-chemical injuries: asam dan alkali
-gas (ledakan gas LPG).
Alkali burns:
- penetrasi yg dalamnekrosis permukaan
epitel dlm bbrp detik vaskularisasi p.drh
Sri Fulina W- RSHJ Sri Fulina W- RSHJ
FKK UMJ 24
limbal berkurang-kekeruhan kornea,
katarak dan simblefaron.
Acid burn :
-kerusakan yg terjadi lebih kurang
koagulasi permukaan epitel tp tidak
terjadi penetrasi.
Symptoms:
- edema palpebra ,mata merah
- refleks blefarospasme
- fotofobia,lakrimasi.
Sri Fulina W- RSHJ Sri Fulina W- RSHJ
FKK UMJ 25
Signs:
- kongesti berat,kemosis konj
- kornea keruh
- tes fluoresin positif
Komplikasi :
- simblefaron
- ulkus kornea
Terapi:
- cuci dgn air mengalir /bersih
- bl ada aberasi beri antibiotik
- steroid dpt diberikan bl tdk ada ggn kornea,
u/ mencegah pembtkn simblefaron.

Sri Fulina W- RSHJ Sri Fulina W- RSHJ
FKK UMJ sri fulina 2011 26
Trauma Kimia
-Kornea jernih
-Tdk ada limbal iskemia
-Kornea keruh tetapi msh tampak
struktur iris
-limbal iskemia < 1/3
Sri Fulina W- RSHJ Sri Fulina W- RSHJ
FKK UMJ sri fulina 2011 27
-Epitel kornea hilang total
-Gambaran iris tdk jelas
-Kornea keruh
-Limbal iskemia >
Sri Fulina W- RSHJ Sri Fulina W- RSHJ
FKK UMJ 28
Prinsip terapi:
Irigasi dgn larutan normal saline,ringer laktat.
Eversi kelopak mata atas dn bawah irigasi
daerah forniks.
Debridement epitel yg nekrosis
Lubrikan topikal dapat membantu reepitelisasi
Bebat tekan& bandage contact lens dapat
mengurangi nyeri.
Sri Fulina W- RSHJ Sri Fulina W- RSHJ
FKK UMJ 29
Irigation
Clean around the eye
with a wet washcloth
first.
Place your eye under a
gently running faucet or
shower. Hold the eyelid
open while you do this.
Or, try to open and
close the eye
repearedly while
submerging that side of
the face in a pan of
water.
Sri Fulina W- RSHJ Sri Fulina W- RSHJ
FKK UMJ 30
Blunt injury ( Contusions )

Mechanical injury of the eye :
1.Closed globe injury;
- contusion -blunt trauma
- lamellar laceration-partial thickness
2. Open globe injury,
- ruptur
- laceration penetrating injury
perforating injury
Sri Fulina W- RSHJ Sri Fulina W- RSHJ
FKK UMJ 31
Effects of blunt injury on
1.Lens: -vossius ring
-traumatic cataract typical Rosette
-subluxation
-dislocation
2.Iris : -miosis ,mydriasis
-hyphaemia
-iridodialysis
-aniridia
Sri Fulina W- RSHJ Sri Fulina W- RSHJ
FKK UMJ 32
Ciliary body : - spasme of accomodation
- cyclodialysis

Choroid : - rupture
- harmorrhage
- detachment
Retina : - macular oedema
- macular degeneration
- tear
- detachment
- proliferative retinopathy
Sri Fulina W- RSHJ Sri Fulina W- RSHJ
FKK UMJ 33
Penetrating and perforating injury
Etiology:
-penetrating inj luka pd bolamata akbt
benda tajam (single full-thickness break)
mis,pisau,jarum,iron partikel ,kaca dll.
-perforating inj,double full thickness or
wound (entrance & exit wounds) pd
bolamata akbt bd tajam.
Perforating lbh serius dan berat (ocular
emergency ).
Sri Fulina W- RSHJ Sri Fulina W- RSHJ
FKK UMJ 34

Sign of perforation of the eyeball :

1. Visual acuity menurun
2. Hipotoni ( IOP rendah )
3. Ant chamber dangkal ( hipema )
4. Pupil berubah bentuk,ukuran dn lokasi
5. Chemosis konj
6. Perdarahan subkonjungtiva
7. Luka ditemukan pd kornea,lensa atau
vitreus.
Sri Fulina W- RSHJ Sri Fulina W- RSHJ
FKK UMJ 35

Aim of treatment :

1.To save the vision
2.To prevent the occurrence of the
sympathetic ophthalmitis.
Principles of treatment :
1. bersihkan luka dan jahit
2. cegah infeksi dgn antibiotik sistemik.
3. antibiotik topikal,atropin,cortikosteroid
bl perlu.
Sri Fulina W- RSHJ Sri Fulina W- RSHJ
FKK UMJ 36
Perforating injury with retained FB
FB 90% iron and steel ,stone,glass,wood.
Partikel ukuran > 2 mm dpt merusak mata
dan penglihatan.
Efek dr tertinggalnya FB:
- Efek mekanik: tergtng lokasi kornea,sklera,
- atau di retina bs - hipotoni.
- Infeksi : jrg
- Perubahan degeneratif---siderosis bulbi dan
chalcosis.
Sri Fulina W- RSHJ Sri Fulina W- RSHJ
FKK UMJ 37
Siderosis bulbi.
akbt metal iron.bs terjd lens,iris,retina.
Chalicosis.
akbt copper bs terjd di kornea,lensa,retina.
- kornea-Kayser-Fleisher ring copper
mengenai descemets membrane.
- lens -- Sunflower cataract
- retina golden plaques
Sri Fulina W- RSHJ Sri Fulina W- RSHJ
FKK UMJ sri fulina 2011 38
Orbital Blowout Fracture
Signs & Sxs:
Enophthalmos
Diplopia
Impairment of eye
movement 2
0
to EOM
entrapment, orbital
hemorrhage or nerve
damage
Orbital emphysema
Infraorbital n. anesthesia
CT should include axial
and coronal cuts
Sri Fulina W- RSHJ Sri Fulina W- RSHJ
FKK UMJ 39
Sympathetic ophthalmitis
Terjd peradangan pd mata yg normal akbt
trauma pd mata yg lain.
Jarang.
Etiologi :
- Selalu akbt perforasi tu mengenai korpus
siliare
- Luka dg inkarserasi iris,korp siliaris ,lensa
sgt berbahaya.
Sri Fulina W- RSHJ Sri Fulina W- RSHJ
FKK UMJ 40
- biasanya dimulai 4-8 mggu stlh trauma.
- tidak terjadi bl luka steril.
Symptoms:
- fotofobia,lakrimasi
- visus menurun tu penglihtan dekat,, ok
mengenai otot siliaris akbt iritasi
simpatetik.
Sri Fulina W- RSHJ Sri Fulina W- RSHJ
FKK UMJ 41

Signs:
- kongesti korp.siliare dan nyeri tekan bm
- keratik presipitat(kp) pd post kornea.
- kekeruhan vitreus
- edema optik disk (kdg ).

Sri Fulina W- RSHJ Sri Fulina W- RSHJ
FKK UMJ 42
Treatment:

1.Propilaksis,
-kortikosteroid dn antibiotik
-repair luka
2.Kuratif , obati sesuai pengobtn
iridosiklitis.
3.Operasi , tergtng kasus.
Sri Fulina W- RSHJ Sri Fulina W- RSHJ
FKK UMJ sri fulina 2011 43

Traumatic hyphema



Sri Fulina W- RSHJ Sri Fulina W- RSHJ
FKK UMJ 44
Hipema
terdapat darah dalam bilik mata depan.
Etiologi:
- bola tennis,batu ,mainan anak (toys).
Terjadi akbt pecahnya p.darah :
- circulus arteriosus iridis mayor
- cab.a,ciliaris
- a.v. koroidal
- plexus venous episklera.
Sri Fulina W- RSHJ Sri Fulina W- RSHJ
FKK UMJ 45
- Total hipema dpt terjadi > 6 hari dgn
TIO > 25 mmHg dpt -Blood staining
cornea.
- Peninggian TIO -glaukoma sekunder
- Peninggian TIO dlm wkt lama dpt -
kerusakan n.optikus.
Sri Fulina W- RSHJ Sri Fulina W- RSHJ
ANTERIOR CHAMBER INJURIES
Blood in the Anterior Chamber
Symptoms
Pain, Blurred vision, History of blunt
trauma
Sign
Blood in the Anterior Chamber. Gross
layering or clot or both, usually visible
without a slit lamp. A total (100%)
hyphema may be black or red; when
black its called 8-ball or black ball
hyphema.

HYPHEMA
Sri Fulina W- RSHJ Sri Fulina W- RSHJ
TRAUMA OCULAR
Sri Fulina W- RSHJ Sri Fulina W- RSHJ
TRAUMA OCULAR
Sri Fulina W- RSHJ Sri Fulina W- RSHJ
Ocular Surface Injuries
PARTIAL-THICKNESS
Signs
The Ant. Chamber isnt entered,
therefore, the cornea isnt
perforated

Workup
1.Complete ocular examination
2.Seidel test. If positive then its
a full-thickness laceration.
CORNEAL LACERATION
Sri Fulina W- RSHJ Sri Fulina W- RSHJ
FKK UMJ sri fulina 2011 50
Sri Fulina W- RSHJ Sri Fulina W- RSHJ
FKK UMJ sri fulina 2011 51
Rupture of Cornea with Iris Prolapsing Out
Sri Fulina W- RSHJ Sri Fulina W- RSHJ
FKK UMJ 52
Traumatic Eyelid Laceration
Sri Fulina W- RSHJ Sri Fulina W- RSHJ
FKK UMJ 53
Laserasi sklera
Sri Fulina W- RSHJ Sri Fulina W- RSHJ
FKK UMJ 54
Laserasi kornea + kebocoran
BMD
Sri Fulina W- RSHJ Sri Fulina W- RSHJ
FKK UMJ sri fulina 2011 55



Sri Fulina W- RSHJ Sri Fulina W- RSHJ
FKK UMJ sri fulina 2011 56
Abrasi kornea
Sri Fulina W- RSHJ Sri Fulina W- RSHJ
FKK UMJ 57
Luksasi lensa

Sri Fulina W- RSHJ Sri Fulina W- RSHJ
FKK UMJ 58
Closed globe injury (Ruptur BM)
Sri Fulina W- RSHJ Sri Fulina W- RSHJ
FKK UMJ sri fulina 2011 59
Trauma Mata
Sri Fulina W- RSHJ Sri Fulina W- RSHJ
FKK UMJ sri fulina 2011 60
1.Anamnese kejadian trauma
2.Pemeriksaan tajam penglihatan kedua mata
3.Pemeriksaan dgn Oftalmoskop
4.Pemeriksaan keadaan mata yg kena trauma
5.Bila ada perforasi,lakukan pemeriksaan
X-ray orbita dgn PA dan Lateral
6.Perawatan luka
7.Pengeluaran bd.asing sesuai dgn fasilitas
dan kemampuan.
8.Rujuk ke Rumah Sakit Pusat.




Penatalaksanaan bd.asing dalam mata yang
penting dilakukan adalah :

Sri Fulina W- RSHJ Sri Fulina W- RSHJ
FKK UMJ 61
Pemeriksaan Visus sangat penting
karena :
- menyangkut segi hukum medis
- evaluasi kemajuan terapi
- menentukan prognosa.
Sri Fulina W- RSHJ Sri Fulina W- RSHJ
FKK UMJ sri fulina 2011 62