Pemicu 5

Niko Hizkia Simatupang

405090117

Trauma pada Mata

Kelopak mata : hematom periokular, laserasi
Apparatus lakrimal : laserasi
Konjungtiva : perdarahan subkonjungtiva,
benda asing
Kornea : edema kornea, benda asing, luka
bakar
Lensa : dislokasi lensa
COA : hifema
Benda asing intraokular, trauma kimia

Trauma to the
eyelid

Periocular Hematoma
S

- A black eye Periocular

consisting of hematoma
a
haematoma
(focal collection
of blood) and/or
periocular
ecchymosis
(diffuse
bruising)
- Edema : the
most common
blunt injury to
the eyelid or
forehead.

Periocular Hematoma

A. Periocular hematoma and

edema
B. Periocular hematoma and
subconjunctival hemorrhage
C. Panda eyes (basis cranial
fracture)

Abrasion and
laceration of the lid

Abrasi Palbera
S

benda
Abrasi
berbentuk palpeb
partikel
ra
yg harus
dikeluarka
n untuk
menguran
gi risiko
tattoing
pada kulit

P
- Benda btk partikel harus dikeluarkan dgn
cara : irigasi luka dgn saline + ditutup dgn
salep AB & kasa steril jar. yg terlepas
dibersihkan & dilekatkan kembali.
- Laserasi partial-thickness di palpebra yg
tdk mengenai tepi palpebra dpt
diperbaiki secara bedah.
- Laserasi full-thickness palpebra yg
mengenai batas palpebra harus diperbaiki
secara hati-hati cegah penonjolan tepi
palpebra dan trikiasis
- Bila perbaikan primer tidak dilakukan
dalam 24 jam edema tunda
penutupan
- Luka harus dibersihkan secara cermat dan
diberikan antibiotik.

Management

Laserasi Kanalikulus
Laserasi di dekat kantus internus seringkali
mengenai kanalikulus.
Penggunaan stent atau intubasi dapat
memperberat derajat kerusakan kanalikulus
risiko stenosis
Perbaikan dengan Veirs rod atau stent lain
Intubasi nasokanalikular silikon dengan Quickert
probes.

Perdarahan
subkonjungtiva

Hematoma Subkonjungtiva
S

- Funduskopi : bila tekanan

- Pengobata
Hematoma
bola mata rendah dgn
subkonjungti
n dini :
pupil lonjong disertai tajam va
kompres
penglihatan menurun dan
hangat
- Akan
hematom subkonjungtiva
eksplorasi bola mata u/
hilang atau
cari kemungkinan adanya
diabsorpsi
ruptur bulbus okuli
dalam 1-2
- Kadang bisa menutup
minggu
keadaan mata yg lbh
tanpa
buruk sperti : perforasi
diobati
bola mata
- Pembuluh darah rentan
dan mudah pecah : usia
lanjut, HT, arteriosklerosis,
konjungtivitis, anemia.

Superficial
foreign body

Subtarsal Foreign Body

S

O
Small foreign
bodies :
particles of
steel, coal or
sand often
impact on the
corneal or
conjunctival
surface.

A
Subtarsal
Foreign Body

P
May be washed
along the tear
film lacrimal
drainage
system or
adhere to the
superior tarsal
conjunctiva in
the subtarsal
sulcus
abrade the
cornea with
every blink
(pathognomoni
c pattern of
linear corneal
abrasions)

Corneal Foreign Body

S

- Leukocytic
infiltration may
also develop
around any
foreign body of
some duration
- Any discharge,
infiltrate, or
significant
uveitis
suspicion of
secondary
bacterial
infection

Cornea
l
Foreig
n Body

- Careful slit-lamp examination

to locate the exact position and
depth of the foreign body.
- The foreign body removed
under slit lamp visualization using
a sterile 26-gauge needle.
- Magnetic removal deeply
embedded metallic foreign body.
- A residual rust ring remove
with a sterile burr, if available.
- Antibiotic ointment + cycloplegic
and/or typical NSAIDs to
promote comfort.

Subtarsal, Abrasion, and Corneal

A. Subtarsal foreign body

B. Linear
abrasion
stained
with
fluorescein
C. Corneal
foreign
body
with
surrounding cellular infiltration.

Benda asing di
permukaan mata
dan abrasi kornea

Abrasi Kornea dan Benda Asing

S

- Nyeri &
mata
merah
krn
iritasi
saat
mata &
kelopak
mata
digerakk
an

- Pola
tanda
goresan
vertikal di
kornea
benda
asing
terbenam
di
permuka
an
konjungti
va
tarsalis
palpebra
superior
Pemakaia
n lensa
kontak yg
berlebiha

Abra
si
Korn
ea
dan
Bend
a
Asin
g

- Pengeluaran benda asing anestetik topikal

+ spud (alat pengorek) / jarum berukuran kecil
mata diberikan salep AB dan ditutup
- Luka diperiksa setiap hari cari tanda-tanda
infeksi sampai luka sembuh sempurna
- Terapi defek epitel kornea : salep AB & balut
tekan imobilisasi palpebra
- Jangan pernah beri larutan anestetik topikal
pada pasien u/ dipakai ulang setelah cedera
kornea

memperlambat
penyembuhan,
menutupi kerusakan lebih lanjut, pembentukan
jaringan parut kornea yang permanen.
- Defek epitel hindari KS
- Abrasi kornea : komplikasi anestesi umum
hindari dgn menutup mata (dengan plester) /
memberi salep pelumas mata di forniks
konjungtiva sewaktu induksi.
- Kdg tjd erosi epitel rekuren terapi :
penutupan, bandage contact lens, mikropungsi
kornea,
excimer
laser
phototherapeutic
keratectomy (PTK)

Benda Asing

Luka bakar
pada mata

Luka Bakar Kimia

S

O
- Basa (alkali)
cepat
menembus
jaringan mata
dan akan terus
menimbulkan
kerusakan lama
setelah cedera
terhenti
- Luka bakar
alkali TIO
- Pelepasan PG
tekanan
sekunder (2-4
jam kemudian)
berpotensi
uveitis berat

A
Luka bakar
kimia

P
- Harus diterapi sebagai
kedaruratan mata.
Segera
lakukan
:
pembilasan dengan air
yang mengalir (air keran)
di lokasi dikirim/dirujuk
- IGD/UGD
anamnesis
dan pemeriksaan singkat
permukaan
mata
dan
forniks
konjungtiva
diirigasi
dengan
cairan
yang sangat banyak
Saline
isotonik
steril
diberikan melalui selang IV
standar
- Blefarospasme spekulum
palpebra mata dan inflitrasi
anestetik lokal

Luka Bakar Kimia

S

- Basa (alkali) Luka bakar kimia Analgesik,

anestetik
cepat
topikal
dan
sikloplegik
menembus
hampir selalu diberikan.
jaringan mata
- Aplikator kapas yang
dan akan terus
dibasahi dan pinset
menimbulkan
mengeluarkan
bendakerusakan lama
benda berbentuk partikel
setelah cedera
dari forniks (contoh :
terhenti
cedera yang berhubungan
- Luka bakar
dengan plaster bangunan
alkali TIO
atau semen)
- Pelepasan PG
- Periksa pH permukaan
tekanan
mata jika pH 7,3-7,7
sekunder (2-4
ulangi irigasi salep
jam kemudian)
antibiotik
dan
balutan
berpotensi
tekan
uveitis berat

Luka Bakar Kimia

S

- Basa (alkali) Luka bakar kimia - Basa (alkali) bilasan

cepat
jangka
panjang
dan
menembus
pemeriksaan pH secara
jaringan mata
berkala.
dan akan terus
- Pelepasan PG potensi
menimbulkan
uveitis berat th/ :
kerusakan lama
Steroid
topikal,
obat
setelah cedera
antiglaukoma,
dan
terhenti
sikloplegik
selama
2
- Luka bakar
minggu pertama
alkali TIO
Setelah
2
minggu,
- Pelepasan PG
pemakaian steroid harus
tekanan
hati-hati

dapat
sekunder (2-4
menghambat reepitelisasi.
jam kemudian)
- Luka bakar alkalis derajat
berpotensi
sedang tetes mata
uveitis berat
askorbat (vitamin C) dan
sitrat

Luka Bakar Kimia

S

O
- Basa (alkali)
cepat
menembus
jaringan mata
dan akan terus
menimbulkan
kerusakan lama
setelah cedera
terhenti
- Luka bakar alkali
TIO
- Pelepasan PG
tekanan
sekunder (2-4 jam
kemudian)
berpotensi
uveitis berat

A
Luka bakar
kimia

P
- Terpajannya kornea dan
adanya defek epitel yang
menetap air mata
buatan,
tarsorafi,
atau
bandage contact lens.
- Kasus-kasus berat
transplantasi epitel limbus
serta
graft
membran
amnion, corneal grafting
membantu
epitelisasi
kornea.

Luka Bakar Kimia

Komplikasi jangka panjang :
Glaukoma,
pembentukan
jaringan
parut
korneam simblefaron, entropion, dan keratitis
sika
Prognosis :
Semakin banyak jaringan epitel perilimbus dan
pembuluh darah sklera dan konjungtiva yang
rusak prognosisi semakin buruk

Luka Bakar Termal

S

- Iradiasi UV keratitis superfisialis Luka

yang nyeri
bakar
- Terpajan bunga api las tanpa termal
perlindungan
suatu
filter,
korsleting pada kabel tegangan
tinggi, atau terpajan pantulan
cahaya dari salju tanpa kacamata
pelindung 6-12 jam nyeri
keratitis superfisialis.
- Energi radiasi dari menatap
matahari atau gerhana matahari
tanpa filter yang sesuai luka bakar
serius pada makula gangguan
penglihatan yang permanen
- Pajanan sinar X yang berlebihan
katarak
- Kerusakan
kornea
yang
berkepanjangan

edema
palpebra yang ekstensif (tindakan
balut tekan tidak berguna) 2-3

P
- Kasus-kasus flash
burn yang parah
pemeriksaan :
penetesan anestetik
topikal steril terapi :
balut tekan + salep
antibiotik.
- Pada palpebra
terapi : antibiotik
topikal dan balutan
steril.
Tarsorafi
dan
moisture chamber
yang
dibuat
dari
plastik melindungi
kornea
- Full-thickness skin
graft ditunda sampai
kontraksi kulit tidak
lagi berlanjut.

Dislokasi lensa

Ectopia Lentis
S

- Displacement of the lens

Ectopia
from its normal position.
Lentis
- Completely dislocated,
rendering the pupil aphakic
(luxated), or partially
displaced, still remaining in
the pupillary area
(subluxated).
- Hereditary or acquired.
- Acquired causes : trauma, a
large eye (e.g. high myopia,
buphthalmos), anterior uveal
tumours and hypermature
cataract.

Without Systemic Association

S

AD condition characterized by
Familial
bilateral symmetrical superotemporal Ectopia
displacement may manifest
Lentis
congenitally or later in life.
Rare, congenital, bilateral, AR
disorder characterized by
displacement of the pupil and the
lens in opposite directions.
- The pupils are small, slit-like
and dilate poorly.
- Other findings : iris
transillumination, large corneal
diameter, glaucoma, cataract
and microspherophakia.
Aniridia is occasionally associated
with ectopia lentis

Ectopia
Lentis et
Pupillae

Without Systemic Association

Ectopia Lentis et pupillae

Inferior subluxation in aniridia

With Systemic Association

S

- Ectopia lentis :bilateral and

symmetrical is present in 80%
of cases.
- Subluxation is most frequently
supero-temporal, but may be in
any meridian.
- Because the zonule is
frequently intact
accommodation is retained,
although rarely the lens may
dislocate into COA or vitreous.
The lens may also be
microspherophakic.

A
Marfan
Syndrome

Marfan Syndrome

Superotemporal subluxation
with intact zonule

Dislocation into the vitreous

(rare)

With Systemic Association

S

- Ectopia lentis : inferior

occurs in 50% of cases during
late childhood or early adult life.
- Microspherophakia is common
so that subluxation occurs
anteriorly to cause pupil block
or occasionally into COA

A
WeillMarchesan
i
syndrome

With Systemic Association

S

- Ectopia lentis : inferonasal, Homocystinur

almost universal by the age of ia
25 years in untreated cases.
- The zonule which normally
contains
high
levels
of
cysteine
(deficient
in
homocystinuria)

disintegrates

accommodation is often lost.

- Secondary angle-closure may
occur as a result of pupil block
caused by lens incarceration in Inferior subluxation
with zonule
the pupil, or a total dislocation
disintegration
into the anterior chamber.

Complication
Refractive error (lenticular myopia)
Optical distortion due to astigmatism and/or lens
edge effect
Glaucoma
Lens-induced uveitis.

Treatment
Spectacle correction correct astigmatism
induced by lens tilt or edge effect in eyes with
mild subluxation.
Aphakic correction afford good visual results
if a significant portion of the visual axis is aphakic
in the undilated state.
Surgical removal of the lens, using closed
intraocular
microsurgical
techniques

intractable ametropia, meridional amblyopia,

cataract, lens-induced glaucoma, uveitis or
endothelial touch.

Hyphema
S

- Contusive forces Hyphem - Treatment prevention of

tear the iris a
secondary
haemorrhage
and
vessels
and
control of any elevation of IOP that
damage
the
may result in corneal blood staining
anterior chamber
.
angle.
- -blocker to lower the
- Blood in the
increased IOP.
aqueous
may
- Topical steroids reduce
settle out in a
inflammation and possibly the risk
visible
layer
of secondary hemorrhage.
(hyphema).
- Surgical evacuation of the
- Hemorrhage in
blood risk of permanent corneal
COA
staining (rare) or persistently
Source
of
intolerable IOP.
bleeding : iris or
- If a total hyphaema persists for >
ciliary body.
5 days consider evacuation
Traumatic
to prevent the occult development
hyphaema

of peripheral anterior synechiae

Hyphema
S

- Contusive forces Hyphem - Visible hyphema filling > 5% of

tear the iris a
the COA should rest.
vessels
and
- Steroid drops.
damage
the
- Pupillary dilation risk of reanterior chamber
bleeding deferred until the
angle.
hyphema
has
resolved
by
- Blood in the
spontaneous absorption.
aqueous
may
- Initial assessment for posterior
settle out in a
segment
damage
:
require
visible
layer
ultrasound examination.
(hyphema).
- The eye should be examined
- Hemorrhage in
frequently for secondary bleeding,
COA
glaucoma, or corneal blood staining
Source
of
from iron pigment.
bleeding : iris or
ciliary body.
Traumatic
hyphaema

Hyphema

A.
B.
C.
D.

Bleeding from the ciliary body

Small hyphema
Total hyphema
Corneal blood staining

Intraocular
Foreign Body

IOFB
S

O
- Infection or
exert other toxic
effects on the
intraocular
structures.
- Notable
mechanical
effects : cataract
formation
secondary to
capsular injury,
vitreous
liquefaction, and
retinal
haemorrhages
and tears.
- Stone and
organic foreign
bodies are
associated
with a higher
rate of
infection

A
Intraocular Foreign
Body
DIAGNOSIS :
- Accurate history
- Examination
possible sites of entry
or exit.
- Gonioscopy and
fundoscopy must be
performed.
- Associated signs (lid
laceration and damage
to anterior segment
structures) must be
noted.
- CT with axial and
coronal cuts to
detect and localize a
metallic IOFB.
-MRI
contraindicated in the
context of a metallic
(specifically ferrous)

P
- Magnetic removal of ferrous
foreign bodies sclerotomy with
application of a magnet followed
by cryotherapy to the retinal
break.
- Scleral buckling reduce the
risk of retinal detachment.
- Forceps removal nonmagnetic foreign bodies and
magnetic foreign bodies that
cannot be safely removed with a
magnet.
- Prophylaxis against
infection.
* Ciprofloxacin 750mg b.d. or
moxifloxacin 400mg daily
open globe injuries, together
with topical antibiotic, steroid
and cycloplegia.
* Intravitreal antibiotics for
high-risk cases (e.g.
agricultural injuries).

IOFB
A.
B.
C.
D.

In the lens
In the angle
In the anterior vitreous
On
the
retina,
associated with preretinal hemorrhage

Eye Chemical
injury

Chemical Injury
S

/3 of accidental burns occur at Eye

work and the remainder at home. chemica
- Alkali burns are twice as l injury
common as acid burns since
alkalis are more widely used both
at home and in industry.
- Alkalis tend to penetrate more
deeply than acids, as the latter
coagulate
surface
proteins,
forming a protective barrier.
- Ammonia and sodium hydroxide
may produce severe damage
because of rapid penetration.
- Hydrofluoric acid tends to
rapidly penetrate the eye
- Sulphuric acid complicated by
thermal effects and high velocity
impact
after
car
battery
explosions.
- 2

P
EMERGENCY TH/
- Copious irrigation
crucial to
minimize duration
of contact with the
chemical and
normalize the pH in
the conjunctival sac
as soon as possible
- Double-eversion of
the upper eyelid
- Debridement of
necrotic areas of
corneal epithelium
- Admission to
hospital severe
injuries (grade 4 3)
to ensure adequate
eye drop instillation in
the early stages.

Eye
chemic
al
injury

TH/
- Most mild (grade 1 and 2) injuries topical antibiotic
ointment for about a week, with topical steroids and
cycloplegics if necessary.
- Steroids reduce inflammation and neutrophil
infiltration, and address anterior uveitis.
- Cycloplegia improve comfort.
- Topical antibiotic drops prophylaxis of bacterial
infection (e.g. chloramphenicol q.i.d.)
- Ascorbic acid improves wound healing, promoting
the synthesis of mature collagen by corneal fibroblasts.
- Citric acid : powerful inhibitor of neutrophil activity
reduces the intensity of the inflammatory response.
- Tetracyclines effective collagenase inhibitors and
inhibit neutrophil activity and reduce ulceration.
- Symblepharon formation lysis of developing
adhesions with a sterile glass rod or damp cotton bud.
- Monitor IOP and treat if necessary; oral
acetazolamide is recommended.
- Surgery

Etiology

Roper Hall Grading

A. Limbal ischemia
B. grade 2 corneal haze
but visible iris details
C. grade 3 corneal haze
obscuring iris details
D. grade 4 total corneal
opacification

Complication
A. Conjunctival bands
B. Symblepharon
C. Cicatricial entropion of
the upper eyelid
D. Keratoprosthesis

Diagnosis : Physical
Examination
Check pH of both eyes not normal irrigation
Asses the extent and depth of injury
The degre of corneal, conjunctival, and limbal
involvement to predict visual outcome
Palpebral fissures and the fornices
IOP increased in acute and chronic alkali
injuries

Symptom

Severe pain
Epiphora
Blepharospasm
Reduced visual acuity

Recommended Treatment
Grade I
Topical antibiotic ointment (erythromycin or similar)
4x/day
Prednisolone acetate 1% 4x/day
Preservative free artificial tears as needed
Pain

consider
short
acting
cycloplegic
(cyclopentolate) 3x/day

Recommended Treatment
Grade II
Topical antibiotic drop (fluoroquinolone) 4x/day
Prednisolone acetate 1% hourly while awake for the
1st 7-10 days epithelium has not healed by day 1014 consider tapering
Long acting cycloplegic (atropine)
Oral vitamin C 2 g 4x/day
Doxycycline, 100 mg 2x/day (avoid in children)
Sodium ascorbate drops (10%) hourly while awake
Preservative free artificial tears as needed
Debridement of necrotic epithelium and application of
tissue adhesive as needed

Recommended Treatment
Grade III
As for Grade II
Consider AMT/Prokera placement ideally performed
in the 1st week of injury

Grade IV
As for Grade III
Early surgery
Significant necrosis Tennoplasty reestablish
limbal vascularity
Severity of the ocular surface damage AMT

Ocular and
orbital trauma

Trauma to the Globe

S

O
- Closed injury due to blunt trauma,
the corneoscleral wall is still intact.
- Open injury full-thickness wound
of the corneoscleral envelope.
- Contusion : closed injury resulting
from blunt trauma damage may occur
at or distant to the site of impact.
- Rupture : full-thickness wound caused
by blunt trauma weakest point may
not be at the site of impact.
- Laceration : full-thickness defect in
the eye wall produced by tearing
injury result of direct impact.
- Lamellar laceration : partialthickness .
- Incised injury : by a sharp object
such as glass or a knife.
- Penetrating injury : single fullthickness wound caused by sharp
object without an exit wound.
- Perforation : 2 full-thickness wounds
(one entry and one exit) caused by a
missile.

A
Trauma to the globe
SPECIAL
INVESTIGATIONS :
- Plain radiographs

foreign body is
suspected
- CT superior to
plain radiography in
the
detection
and
localization
of
intraocular
foreign
bodies.
- MRI
:
more
accurate than CT
in the detection
and assessment of
injuries
of
the
globe
- Electrodiagnosti
c tests useful in
assessing
the
integrity of the
optic nerve and
retina

P
Determination of the
nature and extent of
any
life-threatening
problems.
History of the injury :
the
circumstances,
timing
and
likely
object.
Thorough examination
of the eyes and the
orbits.

Ocular Trauma
S

O
- Common cause
of
unilateral
blindness
in
children
and
young
adults
sustain the
majority
of
severe
ocular
injuries.
- Young adults
(esp : men)
most
likely
victims
of
penetrating
ocular injuries.
- Severe ocular
trauma

multiple injuries
to
the
lids,
globe,
and
orbital
soft

A
Ocular trauma
INITIAL
EXAMINATION :
The
direct
and
indirect
ophthalmoscopes
to view the lens,
vitreous, optic disk,
and retina.
Photographic
documentation for
medicolegal
purposes in all cases
of external trauma.
In all cases of ocular
trauma,
the
apparently uninjured
eye should also be
carefully examined.

P
Analgesics,
antiemetics,
and
tetanus antitoxin are
given as needed.
- Small children may
also
be
better
examined
initially
with the aid of a
short-acting general
anesthetic.
Caution:Topical
anesthetics,
dyes,
and
other
medications placed
in an injured eye
must be sterile. Both
tetracaine
and
fluorescein
are
available in sterile,
individual dose units.

Ocular Trauma

Eyelid laceration with concurrent ocular open

globe injury.
A. Rather innocuous-appearing V-shaped eyelid
laceration involving the upper and lower lid and

Ocular Trauma

Eyelid laceration with concurrent ocular open

globe injury.
B. Total dark red hyphema and hemorrhagic chemosis
are evident when the lids are separated. Note also

Trauma tumpul
bola mata

Blunt Trauma
S

- Etiology : squash balls, elastic

luggage straps and champagne
corks.
- Severe orbital blunt trauma
anteroposterior compression
with simultaneous expansion
in
the
equatorial
plane
associated with a transient
but severe in IOP.
- The impact is primarily
absorbed
by
the
lens-iris
diaphragm and the vitreous
base damage can also occur
at a distant site : posterior pole.
- The extent of ocular damage
depends on the severity of
trauma.
- Commonly results in long-term
effects;
the
prognosis
is

Trauma
tumpul
pada
mata

Glaucoma : topical therapy

with -blockers (timolol
0.25%
2x/day),
prostaglandin
analogs
(latanoprost 0.005% in the
evening), dorzolamide 2%
2-3x/day, or apraclonidine
0.5% 3x/day.
Oral
therapy
with
acetazolamide (250 mg
orally
4x/day)
and
hyperosmotic
agents
(mannitol, glycerol, and
sorbitol)

if
topical
therapy is ineffective.
Glaucoma
drainage
surgery extreme cases.

Blunt Trauma

Blunt Trauma

Trauma tembus
bola mata

Penetrating Trauma
S

- The extent of the injury is Trauma tembus

determined by the size of bola mata
the object, its speed at
the time of impact and
its composition.
- Sharp objects (knives)

well-defined
lacerations of the globe.

Penetrating Trauma
Male : female ration = 3 : 1 , typically occur in a
younger age group (50% aged 1534).
The most frequent causes : assault, domestic and
occupational accidents, and sport.
Extent of damage caused by flying foreign bodies
determined by their kinetic energy.
Risk of infection with any penetrating injury :
endophthalmitis or panophthalmitis loss of the eye.
Risk factors : delay in primary repair, ruptured lens
capsule and a dirty wound.
Any eye with an open injury should be covered by a
protective eye shield upon diagnosis.

Corneal Penetrating Wound

S

- Small shelving wounds Trauma tembus

with
formed
anterior kornea
chamber often heal
spontaneously or with the
aid of a soft bandage
contact lens.
- Medium-sized wounds

require
suturing,
especially if COA is shallow
or flat postoperative
bandage contact lens may
be applied subsequently
for a few days to ensure
that the anterior chamber
remains deep.

P
With
iris
involvement
wounds

require
iris
abscission.
- With lens
damage
wounds

suturing
the
laceration and
removing
the
lens
by
phacoemulsifica
tion or with a
vitreous cutter.

Corneal Penetrating Wound

A. Small shelving with
formed COA.
B. With flat COA.
C. With iris involvement.
D. With lens damaged.

Scleral Penetrating Wound

S

Anterior
scleral Trauma tembus
lacerations have a better sklera
prognosis
than
those
posterior to the ora serrata.
- Anterior scleral wound
serious
complications
:
iridociliary prolapse and
vitreous incarceration.
- Vitreous incarceration
not
appropriately
managed subsequent
fibrous
proliferation
along
the
plane
of
incarcerated
vitreous
and tractional retinal
detachment.

P
scleral suturing
reposit viable
uveal tissue
and cut
prolapsed
vitreous flush
with the wound.

Scleral Penetrating Wound

A. Anterior circumferential scleral

laceration with iridociliary prolapse.
B. Radial anterior scleral laceration
with ciliary and vitreous prolapse.
C. Fibrous proliferation.

Treatment

Anterior segment wounds microsurgical techniques.

Corneal lacerations 10-0 nylon sutures to form a
watertight closure.
Incarcerated iris or ciliary body exposed for < 24 hours
reposition in the globe with viscoelastics or by introducing
a cyclodialysis spatula through a limbal stab incision and
sweeping the tissue out of the wound.
If this cannot be achieved, if the tissue has been
exposed for > 24 hours, or if it is ischemic and severely
damaged prolapsing tissue should be excised at the
level of the wound lip
Lens remnants and blood removed with mechanical
irrigation and aspiration or vitrectomy equipment.

Anterior chamber reformation during repair

viscoelastics, air, or physiologic intraocular fluids.
Scleral wounds closed with interrupted 8-0 or 9-0

Trauma pada Telinga

Trauma aurikuler
Trauma tulang temporal
Barotrauma
Trauma di membran tympani
(perforasi membran tympani)

Trauma
aurikula

Auricular Hematoma
S

- Blunt injury to the auricle Auricular

auricular hematoma.
hemato
- Common injury in sport,
ma
particularly in wrestlers and
boxers.
- Injury to perichondrial BF
blood accumulation in the
subperichondrial space
perichondrium off of the
cartilage not drained
cartilage necrosis.
- The trapped blood and
injured perichondrium
fibrocartilagenous mass
cauliflower ear

P
- Auricular hematoma must
be
evaluated
and
addressed as soon as
possible following the injury
(preferably
within
62
hours).
Long-recommended
treatment : evacuation of
the
hematoma
and
application
of
pressure
dressing prevent reaccumulation of the blood.
- Wide incision with a
scalpel drainage and
removal
of
clot
and
fibroneocartilage bolster
dressing for 7-10 days.

Auricular Hematoma

Burns Trauma
S

- 1st degree burns Burns trauma

scald
injuries
and
results in little necrosis,
inflammation
and
considerable pain.
Usually heals with
no scar
nd
- 2
degree burns
partial thickness burns
epidermolysis and
blistering.
- 3rd degree burns full
thickness and generally
anesthetic significant
tissue loss

P
- 1st degree burns Th/ : NSAID
for pain and emollient creams
- 2nd degree burns Th/ : NSAID,
gentle cleansing and application
of antibiotic ointment
- 3rd degree burns Th/ : 2nd
degree
burn
and
require
reconstructive intervention
- Pressure on the auricle should
be avoided the patient may
need to wear protective cup or
bolster.
- Adequate analgesics to all
patients with burns.
- Complication : perichondritis
(25% of all 2nd and 3rd degree
burns) prevention : topical
antibiotic ointment

Frostbite
S

- Prolonged exposure to T < frostbite

0oC anesthesia, pallor, ice
crystal formation within
tissue.
- With thawing, endothelial
damage severe edema
and sludging of blood
risk of necrosis.
- Acute area be gently
thawed by application of
moist cotton pledgets
slightly warmer than body T.

P
- Compressive
dressing should
be avoided.
- Apply
antibiotic
creams

Trauma tulang
temporal

Temporal Bone Trauma

Physical insult of the temporal bone induced by
impact with a blunt surface of penetrating
missile.
Young men (20-30 y.o) the most commonly
affected group.
Road traffic accident 40-50% traumatic
temporal bone fractures.
Causes : falls, assaults, industrial and sporting
accidents.

Temporal Bone Trauma

S

Hilang
pendengar
an

- 17% of patients will

lose all hearing in the
affected ear as result of
temporal bone fracture.
- Evidence of a
penetrating injury to the
temporal region of the
skull
- Otorrhea
- Bruising over the
mastoid process
(Battles sign)
- LMN N.VII palsy.
- Otoscopy : presence of
fresh blood in EAC,
injury to TM with
perforation,
hemotympanum, step
deformity in the bony
wall of EAC.

A
Trauma tulang
temporal
DIAGNOSIS
- CT Scans
diagnostic gold
standard test.
- MRI evidence of
N.VII injury and
hematoma within
cochlear.
- Hearing
assessment : puretone audiometry,
tympanometry.
- Vestibular
assessment : DixHallpike manoevres,
Romberg test
- Facial nerve function
- CSF, otorrhea,

P
- TM
perforation
which persist
for 3
months after
initial injury
surgical
closure
(tympanoplas
ty).
- Bilateral
profound
SNHL
secondary to
labyrinthine
trauma
cochlear
implant.

Fraktur tulang
temporal

Temporal Bone Fractures

S

edema, hematoma, bleeding, conductive

or SNHL, dizziness, CSF leak, facial
paralysis.

Fraktur tulang
temporal
DIAGNOSIS
HRCT (High
Resolution
Computed
Tomography)

- Run parallel to the long axis of the Fraktur Longitudinal

petrous ridge
- Comprised 70-90% of all temporal bone
fractures and were seen with N.VII injury
10-25% of time.
- Laceration of EAC extending into tears
of TM TM perforation and ossicular
discontinuity HL
- Anterior fractures low incident of
middle meningeal artery laceration
epidural hematoma.
-

Hemotympanum,

SNHL,

vertigo, Fraktur Transversal

P
Surger
y

Barotrauma
(aerotitis)

Otitic Barotrauma
Pathological conditions of the ear induced by
pressure changes.
Commonly occurs in airline passengers, divers,
water skiing etc.
Failure of middle ear pressure equalization
inner ear compression barotrauma.
Decompression and recompression middle ear
barotrauma.

Otitic Barotrauma
S

Pain increasing with

depth, ear canal skin
and TM become
injected and petechial
hemorrhage and even
bleeding.

External ear
barotrauma

- Sensation of a
blocked ear with strong
desire to equalize
otalgia
- Minimal conductive
HL
- Perforation may
occur sudden
severe pain

Middle ear
barotrauma

Dysequilibirum with
manouevres which

Inner ear
barotrauma

Causes : cerumen,
earplugs, foreign
bodies or
exostoses.

Very common
during flight and
scuba diving.

P
clear EAC of blood/wax
debris, antibiotic drops
for secondary infection,
surgical repair of any
perforation if
spontaneous healing
fails, consider
exosrectomy.
- Preventation : oral
pseudoephedrine and
Otovents.
- Treatment : surgical
repair of TM and nasal
septal (vomeroethmoidal) surgery (to
improve the ability to
equalize middle ear
pressure)
Surgery severity of the
HL and failure of the

Middle Ear Barotrauma

Barotrauma

Trauma
membran
tympani

Middle Ear Trauma

S

Pain, conductive /
sensory HL,
disequilibrium,
tinnitus, and rarely
dysgeusia or N.VII
paralysis.

Trauma membran
tympani

- Treatment :
facilitating
spontaneous
closure
debridement of the
canal .
- Perforations > 310 months
tympanoplasty
to reduce the risk
of chronic infection
or cholesteatoma.

- Penetrating
objects :
misguided cotton
tip applicator,
hairpin, key,
pencil, picks and
knives.

Middle Ear Trauma

Injury : localized and often has predictable path.
Complication : delayed infection, otorrhea,
subsequent cholesteatoma formation.
88%
traumatic
perforation
of
TM
heal
spontaneously within 3-10 months related to
size of the perforation.