▪ Nama : Angga Fajriansyah, Dr, SpM

▪ Jabatan : Staf divisi infeksi dan immunologi PMN RS Mata Cicendo

Bandung
▪ Riwayat Pendidikan
2009-2014 : PPDS Ilmu Kesehatan Mata FKUNPAD
▪ Riwayat Organisasi
2009-sekarang : Anggota PERDAMI
2015-sekarang : Anggota International Ocular
Inflammation Society (IOIS)
2015-sekarang : Anggota Indonesian Ocular and
Inflammation Society (INOIIS)
Angga Fajriansyah
Cicendo National Eye Hospital
▪ Accidental eye injury is one of the leading
causes of visual impairmet
▪ > 2.4 million eye injuries in the US per year
▪ Indonesia??
▪ 90% preventable
▪ Visual Acuity
▪ Motility
▪ Pupils
▪ Visual Field
▪ Inspection
▪ Orbital/Ocular trauma : ▪ Infection and inflammation :
▪ Corneal abrasion ▪ Orbital cellulitis
▪ Corneal ulcer ▪ Endophthalmitis

▪ Chemical injury
▪ Corneal and conjunctival ▪ Acute vision loss :
foreign bodies ▪ Acute angle closure glaucoma
▪ Hyphema ▪ CRAO

▪ Ruptured globe
▪ Orbital wall fracture ▪ Others :
▪ Retinal detachment
▪ Lid Laceration
▪ History of scratching the eye
▪ Symptoms:
▪ Foreign body sensation
▪ Pain
▪ Tearing
▪ Photophobia

▪ Treatment:
▪ Topical antibiotic
▪ Pressure patch over the eye
▪ Refer to ophthalmologist
▪ Corneal ulcer occur secondary to lid and
conjunctival inflammation but is often due to
trauma or contact lens wear
▪ Any redness occurring for patients who wear
contact lens should be managed with extreme
caution
▪ Remove lens
▪ Rule out corneal infection
▪ Antibiotics for gram negative organisms
▪ Do not patch
▪ Follow up with ophthalmologist in 24 hours
▪ A vision-threatening emergency
▪ The offending chemical may be in the form of a solid, liquid, powder,
mist, or vapor
▪ Alkali or acid treat the same
▪ Can occur in the home, most commonly from detergents,
disinfectants, solvents, cosmetics, drain cleaners…..etc

▪ Can range in severity from mild irritation to complete

destruction of the ocular surface
▪ Management
▪ Instill topical anesthetic
▪ Check for and remove foreign bodies
▪ Immediate irrigation essential, preferably with saline or Ringer’s
lactate solution, for at least 30 minutes
▪ Irrigation should be continued until neutral pH is reached
(i.e.,7.0)
▪ Instill topical antibiotic
▪ Frequent lubrications
▪ Oral pain medication
▪ Refer promptly to ophthalmologist
▪ Management
▪ Instill topical anesthetic
▪ Removal of the foreign body
▪ Topical antibiotic
▪ Treat corneal abrasion
▪ Can occur with blunt or penetrating injury
▪ Blood in the anterior chamber

▪ Can lead to high intraocular pressure

▪ Detailed history
▪ Management
▪ Bed rest
▪ Topical steroid
▪ Topical cycloplegic
▪ Antifibrinolysis agents (Tranexamic acid)
▪ Surgical evacuation
▪ Suspect a ruptured globe if:
▪ Severe blunt trauma
▪ Sharp object
▪ Bullous subconjunctival hemorrhage
▪ Uveal prolapse (Iris or ciliary body)
▪ Irregular pupil
▪ Hyphema
▪ Vitreous hemorrhage
▪ Lens opacity
▪ Lowered intraocular pressure
▪ Stop examination
▪ Shield the eye
▪ Give tetanus prophylaxis
▪ Refer immediately to ophthalmologist
▪ Assess ocular motility
▪ Assess sensation over cheek and lip
▪ Palpate for bony abnormality
▪ Can result from sharp or blunt trauma
▪ Rule out associated ocular injury
▪ Should always be concerned about underlying open globe
▪ Refer to ophthalmologist for
– Full-thickness laceration
– Laceration involving medial 1⁄3 of lid
– Deep lacerations with or without fat prolapse – Lacerations with significant tissue
loss
▪ Cover with damp, sterile dressing
▪ Result from peripheral iris blocking the outflow of fluid

▪ Present with pain, redness, mid-dilated pupil with decrease vision and coloured haloes around
lights
▪ Severe headache or nausea and vomiting
▪ Intraocular pressure is elevated
▪ Can cause severe visual loss due to optic nerve damage
▪ Immediate treatment:
Timolol
Apraclonidine
Prednisolone acetate
▪ If IOP > 50 mm Hg or severe vision loss:
Acetazolamide 500mg IV
▪ If no decrease in IOP or vision improvement:
IV Mannitol
▪ Pilocarpine 1-2% in affected eye, pilocarpine 0.5% in contralateral
eye (after IOP < 40 mm Hg)
▪ Immediate Ophtho consult
▪ Causes
Thrombosis, embolus, giant cell
arteritis, vasculitis, sickle cell disease,
trauma
▪ Painless vision loss
May be complete or partial
▪ Afferent pupillary defect
▪ Pale fundus with narrowed arterioles
and segmented flows (boxcars) and
bright red macula (cherry red spot)
▪ Treatment:
Ocular massage!
▪ 15 seconds of direct pressure with
sudden release
Topical timolol or IV acetazolamide
Emergent Optho eval
▪ Pain
▪ Decreased vision
▪ Impaired ocular motility/double vision
▪ Afferent pupillary defect
▪ Conjunctival chemosis and injection
▪ Proptosis
▪ Optic nerve swelling
▪ Management reffer to ophthalmologist
▪ Admission
▪ Intravenous antibiotics
▪ blood cultures
▪ Surgery maybe necessary
▪ Potentially devastating complication of any
intraocular surgery
▪ Any patient in the early postoperative period
(within 6 weeks of surgery) c/o pain or
decrease vision should be evaluated
immediately
▪ Management :
▪ Vitreous sample for culture
▪ Intravitreal antibiotics injection plus topical
antibiotics and corticosteroids