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OCULAR TRAUMA

CYNTHIA OKTORA DWIYANA


I11109063
 Blunt Trauma
 Sharp Trauma
 Chemical Trauma
 Foreign Body
Anterior

Conjuncti Cornea Sclera Anterior Iris/Pupil


va Chamber
Blunt Abrasion Abrasion Laceration Hyphema Iris/Pupil
Laceration Laceration irregularity
Penetrating Laceration Laceration Laceration Hyphema Iris/Pupil
Prolapse irregularity,
prolapse
Perforating Laceration Laceration Laceration Hyphema Iris/Pupil
Prolapse irregularity,
Prolapse
Posterior

Lens Vitreous Retina Choroid


Blunt Traumatic Hemorrhage Commotio Choroid
Cataract retinae, rupture,
Retinal holes, Prolapse
detachment,
etc
Penetrating Traumatic Hemorrhage Laceration, Choroidal
cataract, Prolapse prolapse, prolapse,
Prolapse Retinal Laceration
detachment
Perforating Traumatic Hemorrhage Laceration, Choroidal
cataract, Prolapse prolapse, prolapse,
Prolapse Retinal Laceration
detachment
Blunt Trauma

 Mild – moderate
 “bruise” ocular tissues

 Eye wall intact

 Moderate – severe
 Rupture eye wall

 Very severe consequences


Racoon Eye
Hyphema
Traumatic Cataract
 Often there will be blood in the anterior chamber,
which will initially prevent the examiner from
evaluating the more posterior intraocular structures.
 Treatment:
 Iridodialysis : suture the base of the iris
 Hyphema : patient should assume an upright
Sharp Trauma

 Sharp objects, e.g. glass, spiky plant, hammer and


chisal, cause eyelid, corneoscleral, iris, lens and
retinal lacerations.
 It will lead microarganism easily to penetrate
intraokular
 Sign
 Decrease visus
 Low IOP
 Treatment
 Antibiotic broad spectrum

 Analgesic
Chemical Injuries

 Chemical injuries are among the most dangerous


ocular injuries. First aid at the site of the accident is
crucial to minimize the risk of severe sequelae such
as blindness

 Generaly chemical trauma divided 2 form


 Acid

 Alkali
Acid burn (coagulative necrosis)

 Acids differ from alkalis in that they cause


immediate coagulation necrosis in the superficial
tissue
 This has the effect of preventing the acid from
penetrating deeper so that the burn is effectively a
self-limiting process
Alkali burn (liquefactive necrosis)

 Alkalis differ from most acids in that they can


penetrate by hydrolyzing structural proteins and
dissolving cells
 This is referred to as liquefactive necrosis
 They then cause severe intraocular damage by
alkalizing the aqueous humor
Symptoms:

 Epiphora, blepharospasm, and severe pain are the


primary symptoms.
 Acid burns usually cause immediate loss of visual
acuity due to the superficial necrosis.
 In alkali injuries, loss of visual acuity often manifests
it self only several days later.
Treatment

 IMMEDIATE - EYE IRRIGATION FOR CHEMICAL BURNS


1. Instil local anaesthetic drops to affected eye/eyes.
2. Commence irrigation with 1 litre of a neutral solution,
eg N/Saline (0.9%), Hartmann’s.
3. Evert the eyelid and clear the eye of any debris /
foreign body that may be present by sweeping the
conjunctival fornices with a moistened cotton bud.
4. Continue to irrigate, aiming for a continuous irrigation
with giving set regulator fully open.
5. Review the patient’s pain level every 10 minutes and
instil another drop of local anaesthetic as required.
6. After one litre of irrigation, review.
7. Wait 5 minutes after ceasing the irrigation fluid then
check pH. Acceptable pH range 6.5-8.5.
 Medication
 Antibiotic

 Steroid

 Vitamin C
Prognosis and possible complications

 The degree of ischemia of the conjunctiva and the


limbal vessels is an indicator of the severity of the
injury and the prognosis for healing.
 The greater the ischemia of the conjunctiva and
limbal vessels, the more severe the burn will be. The
most severe form of chemical injury presents as a
“cooked fish eye” for which the prognosis is very
poor, i.e., blindness is possible.
Foreign bodies
– Severity of inflammation depends on type of foreign body:
– Severe inflammatory reaction
• Iron, steel, copper, vegetable matter
– Mild inflammatory reaction
• Nickel, aluminum, mercury, zinc
– Inert
• Carbon, coal, glass, ead, plaster, platinum, porcelain, rubber,
silver, stone
• Even inert FB can be toxic if coated with chemical additive
 Conjunctiva/Cornea
 History – mechanism of injury

 VA

 Slit lamp exam (evert lids - because everytime he closes open


lids  abrasion)
 Fundus exam to rule out intraocular FB

 Check for ruptured globe

 Remove under the slit lamp (sometimes using Tuberculin


syringe) with topical anesthetic
Corneal & Conjunctival Foreign Body
 Intraorbital/ Intraocular
 Always have a high index of suspicion especially if the
mechanism of injury is suggestive of FB
 Do no harm

 Ancillary tests

 Surgical intervention

 Infection coverage
 Treatment:
 Inspection the eye

 Everted uper eyed lid

 If the foreign bodies found give local anaesthetic

 If the foreign body is loose, irrigate the eye

 Remove the foreign body with cooton wool bud, If the


foreign body is adherent

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