TRAUMA OKULI

Roidah Taqiyya Zahra Wathoni

 EXAMINATION

History Taking When? Where? MOI?

Type of injury?

Snellen chart, finger counting, hand

Vision movement, light perception

Ocular examination penlight, loupe, slit lamp

Imaging skull x-ray, USG, CT scan

GLOBE INJURY
Birmingham Eye Trauma Terminology System (BETTS), 2008
Term Definition and Explanation
Eyewall Sclera and Cornea
Closed Globe No full-thickness wound of eyewall
Injury Full-thickness wound of the eyewall
Open Globe There is no (full-thickness) wound
Injury Partial-thickness wound of the eyewall
Contusion Full-thickness wound of the eyewall, caused by a
Lamelar laceration blunt object
Rupture Full-thickness wound of the eyewall, caused by a
Laceration sharp object
Penetrating Injury Entrance wound
Perforating Injury Retained foreign object(s)
Entrance and exit wound

Birmingham Eye Trauma Terminology System (BETTS), 2008

Kuhn et al. (2008)
Ocular Trauma Score (OTS) by Kuhn F, et al, 2002
 How to refer the patient?
Shield the eye appropriately

Symptomatic treatment (pain, nausea, coughing, high blood

pressure, and extreme anxiety)

Antibiotic therapy (usually not necessarily be given)

Tetanus prophylaxis

Kuhn et al. (2001)

 TYPES OF TRAUMA

Mechanics Chemical Physical

Base Rays
Palpebral Injury

Orbital wall fractures Acid Burn

Eyewall Injury Explosive

 MECHANICS

1. Palpebral Injury
2.Orbital Wall Fractures
3.Eyewall Injuries
1. PALPEBRAL INJURY
Palpebral Hematoma

Palpebral Abrasion

Palpebral Laceration
Palpebral Hematoma
Most likely occur in blunt
trauma in palpebral and frontal
Other condition :
- orbital trauma
- eyewall trauma
- orbital wall fracture
- Skull base fracture

Treatment : cold compress

Palpebral Abrasion
Do not penetrate the palpebral
skin

Treatment :
- Cleanse with normal saline
- Antibiotic topical
- Eye shield
Palpebral Laceration Sharp object

Depth Location

- partial thickness - 1/3 medial

- full thickness - middle
- lateral
partial thickness full thickness 1/3 medial
2. ORBITAL WALL FRACTURE
Blow Out Injury

Inferior Wall Fracture

Medial Wall Fracture

Lateral Wall Fracture

Superior Wall Fracture

Blow Out Injury

Sudden increase of IOP due to

trauma of blunt object with diameter
of > 5cm

Intra orbital trapping

- Edema and ecchymosis
- Infra orbital nerve anesthesia
- Diplopia
- Eye wall damage
- Enophthalmus
Medial Wall Fracture

- Commonly occur with

inferior wall fracture
- emphysema
- disruption of abduction
and adduction
3. EYE WALL INJURIES
Conjunctival Bleeding
Corneal erosion
Corneal ulcer
Scleral open wound
Foreign Body
Penetrating trauma
Blunt Trauma (Hyphema)
CHEMICAL

1. Base injury
2.Acid injury
Roper Hall Calssification (2015)
PHYSICS

1. UV Rays
2.Thermal Burn
3.Explosive
1. UV Rays
Welding Beam

Delayed manifestation: pain occur after 6-12 hours

 What to do?
Pantocain drop 0.5%
Antibiotic EO
Eye shield

Keratitis Superficial Healing in 12-36h

2.Thermal Burn
The globe is usually preserved by the palpebral due to corneal reflex

Periorbital thermal injury Globe thermal injury

What to do? What to do?

Topical Antibiotic Refer!
Sterile shield No eye shield
Roper Hall Calssification (2015)
 EMERGENCY

TRUE EMERGENCY URGENT SEMI URGENT

Chemical Injuries Corneal laceration Subconjunctival bleeding

Hyphema Palpebral hematoma

Palpebral laceration

Scleral laceration

Corneal foreign body

Conjunctival foreign body
TRUE EMERGENCY
CHEMICAL INJURY

Clinical manifestation:
Blurred vision
Pain
Redness
Watery
Photophobic
Blepharospasm
 What to do?
1st: Pantocain 0.5%

Most important: Irrigate copiously

Check the pH a few min after
1h : base injury
irrigation. Continue irrigation
30min : acid injury
until the pH reaches 7.0

Remove the foreign body

Topical Antibiotic

Eye Shield

REFER!
URGENT
1. CORNEOSCLERAL LACERATION Sharp objects

Partial thickness Prolapse of vitreous, choroid >

Full thickness Double perforation

Clinical Manifestation: What to do?

- blurred vision Pantocain drop 0.5%
- pain Antibiotic ED
- bleeding Systemic antibiotic
- coarse cornea Eye shield
- blefarospasm
- decrease of IOP
- irradier pupil
- hyphema REFER!
2. HYPHEMA
3. PALPEBRAL LACERATION

Partial Thickness :
Full Thickness
skin
Lid margin
+
Lacrimal system
m. orbicularis oculi

Skin suture REFER!

4. FOREIGN BODY
CORNEA CONJUNCTIVA EYE WALL

Triad of Cornea Pain, epiphora, foreign Pain, epiphora, foreign

body sensation body sensation

Fluorescein Test
Foreign Body Foreign Body
Foreign Body

Extraction of FB Systemic Antibiotic

ATS
Failed > REFER! Eye shield

Pantocain ED 0.5%
DO NOT EXTRACT!
Antibiotic EO/ED REFER!
Eye shield
SEMI URGENT
THANK YOU
Danke Schn