OCULAR TRAUMA

ZALDI
FAKULTAS KEDOKTERAN
UNIVERSITAS MUHAMMADIYAH SUMATERA UTARA
MEDAN
2013
OCULAR TRAUMA

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Dengan menyebut nama Allah

Yang Maha Pengasih Maha Penyayang.

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I. TUJUAN INSTRUKSIONAL UMUM

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Setelah Proses Belajar Mengajar mahasiswa

mampu menegakkan diagnosa trauma okuli
dengan
melakukan
anamnese
dan
pemeriksaan sederhana yang akan dipelajari
selama masa perkuliahan dengan baik dan
benar .

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II. TUJUAN INSTRUKSIONAL KHUSUS

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Setelah Proses Belajar Mengajar mahasiswa

mampu mengetahui tanda dan gejala , faktor
resiko, prinsip pengobatan, komplikasi, dan
mengkonsulkan secara garis besar dengan
baik dan benar kasus-kasus trauma okuli
sesuai dengan kompetensinya

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OCULAR TRAUMA ( INJURIES )

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MECHANICAL INJURIES

NON MECHANICAL INJURIES

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MECHANICAL INJURIES
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1.
2.
3.
4.
5.

Extraocular foreign bodies

Blunt trauma
Perforating injuries
Perforating injuries with retained IOFB
Sympathetic ophthalmitis

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NON-MECHANICAL INJURIES
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1. CHEMICAL INJURIES
Acid burns
Alkali burns
2. THERMAL INJURIES
3. ELECTRICAL INJURIES
4. RADITIONAL INJURIES
Ultraviolet radiations
Infrared radiations
Ionizing radiational injuries
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EXTRAOCULAR FOREIGN BODY

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BLUNT INJURIES
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BLUNT INJURIES
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PERFORATING INJURIES
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PERFORATING INJURIES
WITH INTRA OCULAR FOREIGN BODIES
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PERFORATING INJURIES
WITH INTRA OCULAR FOREIGN BODIES
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BLUNT INJURIES
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CHEMICAL INJURIES
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INTRODUCTION
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Ocular trauma is a common cause of

unilateral blindness in children and young
adults
Domestic accidents, violent assaults,
exploding
batteries,
sports-related
injuries, and motor vehicle accidents are
the most common.
Severe ocular trauma may cause multiple
injuries to the lids, globe, and orbital soft
tissues

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PHYSICAL EXAMINATION
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ANAMNESIS : a history of hammering,

grinding, or explosions, and appropriate
imaging studies must be performed , child
abuse.
VISUAL ACUITY : visual loss was slowly
progressive or sudden in onset.
OCULAR MOTILITY
PERIORBITAL SKIN SENSATION
PALPATE BONY ORBITAL RIM

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PHYSICAL EXAMINATION
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The corneal surface is examined for

foreign bodies, wounds, and abrasions.
The bulbar conjunctiva is inspected for
hemorrhage,
foreign
material,
or
lacerations.
The depth and clarity of the anterior
chamber are noted.
The size, shape, and light reaction of the
pupil.

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PHYSICAL EXAMINATION
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A soft eye, vision of hand movements only (or

worse), an afferent pupillary defect, or vitreous
hemorrhage is suggestive of globe rupture.
If the eyeball is undamaged, the lids, palpebral
conjunctiva, and fornices can be more thoroughly
examined, including inspection after eversion of
the upper lid.
The direct and indirect ophthalmoscopes are
used to view the lens, vitreous, optic disk, and
retina.
Photographic documentation is useful for
medicolegal purposes in all cases of external
trauma.
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CHEMICAL INJURIES ( BURNS )

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All chemical burns must be treated as

ophthalmic emergencies. Immediate tapwater lavage should be started at the site
of injury before the patient is transported.
Sterile isotonic saline ( several liters )
Analgesics and topical anesthetic and
cycloplegic agents are nearly always
indicated.

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ALKALI BURN
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Since alkali rapidly penetrates through ocular

tissues and will continue to cause damage
long after the injury is sustained, prolonged
lavage and repeated pH checks are needed.
Alkali burns cause an immediate rise in
intraocular pressure owing to contraction of
the sclera and trabecular meshwork damage.
Corneal exposure and persistent epithelial
defects are treated with artificial lubricants,
tarsorrhaphy, or a bandage contact lens.

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COMPLICATIONS
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ENTROPION
SYMBLEPHARON
KERATITIS SICCA
CORNEAL SCARRING
GLAUCOMA

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THERMAL BURNS
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Thermal burns of the lids are treated with

topical antibiotics and sterile dressings.
If corneal damage is sustained, the
extensive lid swelling initially makes
pressure patching unnecessary.

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RADITIONAL INJURIES
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ULTRAVIOLET RADIATIONS
INFRARED RADIATIONS
IONIZING RADITIONAL INJURIES

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INFRARED RADIATIONS
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Infrared exposure rarely produces an ocular

reaction. ("Glassblower's cataract" is rare
today but once was common among workers
who were required to watch the color
changes in molten glass in furnaces without
proper filters.)
Excessive exposure to radiation (x-ray)
produces cataractous changes that may not
appear for many months after the exposure.
The same risk is inherent with exposure to
nuclear radiation.

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ULTRAVIOLET IRRADIATION
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Ultraviolet irradiation, even in moderate

doses, often produces a painful superficial
keratitis. Pain often begins 6 - 12 hours
after exposure. This keratitis follows
exposure to an electric welding arc
without the protection of a filter, short
circuits in high-voltage lines, or exposure
to the reflections from snow without
protective sunglasses ("snow blindness").

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PREVENTION
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EYE PROTECTION :
EYE GLASSES
SOLID WRAP AROUND FRAME ; In athletic or
high-risk recreational activities (eg, air or paintpellet gun "war games"), guards without lenses
do not always protect the eye adequately.
Proper eye protection is particularly indicated for
those playing racquetball, handball, and squash.
The sight of many eyes has been lost in these
sports, particularly from ocular contusion trauma
in the absence of adequate eye protection.

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REFERENCES
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American Academy of Ophthalmology, External Disease

and Cornea , Section 8, 2011-2012
American Academy of Ophthalmology, Lens and Cataract ,
Section 11, 2011-2012
American Academy of Ophthalmology , Orbit , Eyelids and
Lacrimal System , Section 7 , 2007-2008
Khurana AK, Comprehensive Ophthalmology, Fourth
Edition , New Delhi, New Age Internasional (p) Limited
Publisher, 2007.
Vaughan & Asbury's :
General Ophthalmology
17th Edition , Mc Graw- Hills Companies , May 2007

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Segala puji bagi Allah, Tuhan semesta alam.

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31

THANKS YOU

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