Ocular trauma

Fakultas Kedokteran
Universitas Syiah Kuala
 Classification of Ocular Trauma
• Ocular trauma without penetration and
perforation:
– Superficial corneal damage
• corneal abrasion
• corneal foreign bodies
– Chemist and physical trauma
• chemist trauma
• physical trauma
– Concusio and contusio of the eye ball
• Concusio caused by air conduction
• Concusio caused by tissue conduction
• Contusio of the eye ball
• Ocular trauma with penetration and perforation:
– Penetration occurred
– Perforating occurred (perforating trauma)
• Without foreign bodies lived :
– corneal wound
– sclera wound
– wound with infection
• Intra Ocular With foreign bodies :
– metallic foreign bodies
– non metallic foreign bodies
• Classification by trauma variation:
– blunt trauma : shuttle cock, stone
– sharp trauma : knife, scissors, gas weapon
– chemist trauma : acid, strong alcaly
– thermal trauma : burning wound
– trauma compression : dynamite
 INTRODUCTION
• Ocular trauma still occurred even there is a
defense mechanism of the eye
• Clinical symptoms :
– pain
– photophobia
– lacrimation
– pupil midriasis
– decreased of light reflex
– anisokor
• Examination :
– Patient History
– Visual acuity (Visus)
– Oftalmoscop : for observing intra ocular (lens,
vitreus, retina)
– slit lamp : at perforating trauma
– roentgen : if foreign bodies suspected
• General Practitioner can handling :
– chemist trauma
– palpebral trauma or conjungtival tearing ---> if
do not affect at lachrimal apparatus
– Corneal foreign bodies
– Th/:
• Chemest :
– Irigated with water or physiological NaCl as much as
possible
– Do not try to netralized thr chemical substance
– Wall chalk (Ca(OH)2)--> the most frequent cause
• Procedure :
– Local anesthesia with pantocain 2 - 5 %
– irrigate approximately 30’ with water
– Apply corticosteroid ointment 3 - 4 times/day
– Foreign body of the chemist substance must be
removed if present
– If the calcium substance already have a fussion
with eye tissue ---> must me remove by EDTA
• Palpebral Trauma :
– Vulnus Scissum/laceratum palpebra are hected
with 5.0 silk ---> margo palpebra are hected
first
– Avoid to much necrotomy ---> to prevent
ectropion occurred
– Palpebra must be well hected --> to avoid
coloboma palpebra
– Wound that prapendicular to margo at canthus
medialis ---> incontinuiting canaliculus
lacrimalis ---> the patient must be reffered to
higher center
• Vulnus Conjunctiva :
– If < 5 mm ----> neglected
– If > 5 mm ---> must be hected with silk 7.0/6.0
in order to accelerate healing proccess
– Procedure :
• Pantocaine 2 - 5%
• Hecting
• Antibiotics ointment
• Bandage
• Corneal Foreign Bodies
– Usually steel powder or metal flash from grainder
– Th/ (use loupe, or biomicroscope if alvailable):
• Pantocain 2-5%
• Foreign bodies are collected by star mesh or syringe needle -->
if patient no cooperative ---> refer
• If the patient are come more than 24 hours ---> corrosive
process already occurred ---> the metal particel are bigger and
more deeper location, so the removing process cannot take one
times and need to be retaken in 2 or 3 days later
• Antibiotics ointment
• bandage
• control in 3 days after
• Contra indication : Corticosteroid
• Symptom :
– Visual acuity is realy decreased if the foreign
bodies are located centre of the cornea, because
nebula/makula cornea are occurred in visual
zone
 Combustio Bulbi
• Thermal :
– caused by hot things : hot water, hot steam, fire, sharp
rays
– Chemical :
• Chemist substance
– Strong Alkali : KOH, NaOH, Ca(OH)2, etc
– Strong Acid : nitrit acid, HCl, sulfat, etc
– Prognosa :
• Alkali is more dangerous than acid substance because necrosis
is not occurred in alkali burn so the substance are penetrating
fast through the eye ball
• At acid burn, necrose are occurred and act as a barier from
penetration of the chemist substance
 Grading of Combustio
Bulbi/Cornea
• Grade I : Combutio Erytematosa
– Blood vessel hyperemia are increased until conjunctiva
edema happen (chemosis)
• Grade II : Combustio Bulosa
– Demage of superficial cells ---> forming bullas
– If bullas broken ---> wound (ulcus)
• Grade III : Combustio Escharotica (carbonitatio)
– Presence of fibrin exudate and demage of the tissue
(necrosa). The necrose tissue whitening ----->
Carbonisatio
• Th:/
– Irigating
• Strong acid with bicarbonate thin solution (0,5 - 1%)
• Permanganat kalikus solution 1/5000
• Complication :
– symblefaron, can avoid with corticosteroid
ointment
 Blunt Trauma
• Concussio bulbi :
– blunt trauma without vascular damage
• Contussio bulbi can make :
– concussio and contussio at cornea --> “ring
shaped” or Descemet/Bowman pleat
– corneal erosio :
• fluorescence test (+), increasing sensibility
• if not infection : recovery in 24 hours
– Echymosis (sub conjunctival haemorrhage) :
• not dangerous and self healing
– Hyphaema :
• associate blood in anterior optic body
• signs :conjunctival injectie, midriasis pupil/normal,
1/~ (if full), secondary haemorrhagie at 3rd-5th day
– Glaucoma :
• damage of trabecular meshwork
• Th/ : glaucoma drugs
– Sub luxatio :
• ICCE --> if occurred through the COA
– Cataract traumatica :
• caused by ruptured of the lens capsule
• lens usually have to extracted several months after
trauma occurred
– Iridodialysis :
• can closing the pupil in severe conditions
• if all of iris loose from the base --> aniridia
traumatica
– Vitreus hemorrhage :
• decreasing of visual acuity
• D/: slit lamp
• Th/: conservative, bandage, hematropin 5%
– Spasm paralytic from used of accommodation
drugs ---> visual acuity disturbance (usually
temporally)
– Retinal bleeding
– Retinal detachment (ablation retina)
– ruptured of sclera
 Perforating Trauma
• Divided in 4 emergency types :
– immediate trauma :
• vulnus scissum and laseratum at cornea :
– small wound : self limited healing
– Th/ : wound cleansing with physiological NaCl, SA,
antibiotics, bandage
– trauma with infection :
• corneal wound adhesion of dirty things --> necrosis
all of cornea caused by pyogenic bacteria
• presence of ring abscess
• Th/: antibiotics
– Iridosiklitis post trauma :
• sequele that usually happened in perforating wound
which give inflammation process but looks like
clean when the trauma happened
• Th/ : local and systemic corticosteroid
– Sympathetic ophthalmic :
• severe complications in a perforating trauma
• wound in ciliary zone seems to be dangerous zone
• occasionally self limiting
 Perforating Trauma with the
Foreign Body Left
• This condition occurring 3 different effect
– mechanical effect :
• foreign body can remains in the eyes, and makes
negative effect in the eye
– infection :
• ocular tissue reaction toward foreign bodies :
– organic substance
– inorganic substance