OCULAR TRAUMA

Dr SENYUM INDRAKILA,dr, SpM

 1. Introduction

• Ocular trauma is a disease with bimodal age

distribution; late of adolescence, early
adulthood, & older than 70.
• Severe ocular trauma, vision threatening eye
injuries, effects men 3-5 times as frequently as
women
• Significant cause of visual loss
• Largely preventable, especially in workplace
• Ocular trauma is a recurrent disease

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The Injured Eye

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 2. Type of injuries

• Mechanical injuries
– Sharp trauma
– Blunt trauma

• Non-mechanical injuries:
– Chemical injuries
– Photic trauma
– Electrical trauma

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 3. History and examination of
the injured eye
• General medical evaluation
• History
• Examination
• Radiologic imaging
• Management

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 3.1. History

Details of the traumatic incident should be

recorded:
1. Date, time and location of incident
2. Mechanism of injury
3. Accidental, intentional, or self-inflicted injury
4. Accident setting
5. Use of contact lenses, corrective glasses, or
safety glasses at a time of accident
6. Presence of witnesses to the accident
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 3.2. Examination

• Visual acuity
• Pupils
• Brightness testing and color vision
• Visual fields
• Extraocular motility
• Intraocular pressure
• External examination: head, face, periorbital
area, eyelid

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 3.3. Examination con’t

• Conjuctiva
• Cornea
• Anterior chamber
• Iris
• Lens
• Vitreous
• Retina and choroid
• Optic nerve

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 3.4. Radiologic Imaging

• Plain radiography
• Computed tomography
• Magnetic resonance imaging
• Ultrasonography

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 3.6. Management of Ocular Injuries

• Emergency procedure (Pertolongan Pertama

Pada Kecelakaan/ PPPK)

• Referral

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 4. Definitions and classification
in ocular trauma

• Birmingham Eye Trauma Terminology System

(BETTS)

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Birmingham Eye Trauma Terminology System (BETTS)

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Birmingham Eye Trauma Terminology System (BETTS)

TERM DEFINITION
Eye wall Cornea & sclera
Closed-globe injury No full-thickness wound of eyewall
Open globe injury Full-thickness wound of the eyewall
Contusion There is no (full-thickness) wound
Lamellar laceration Partial-thickness wound of the eyewall
Rupture Full-thickness wound of the eyewall,
caused by a blunt object
Laceration Full-thickness wound of the eyewall,
caused by a sharp object
Penetrating injury Entrance wound
Perforating injury Entrance and exit wounds

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 5. Closed Globe Injuries

• Ocular Suface (Conjunctiva, Cornea, and

Sclera)
• Anterior Chamber
• Lens
• Posterior Segment
• Eyelid Lacerations
• Orbital Trauma

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 5.1. Closed Globe Injuries: Ocular
surface

• Traumatic subconjungtival hemorrhage

• Corneal abrasions
• Corneal foreign bodies
• Chemical injuries
• Conjunctival lacerations
• Lamellar corneal and scleral lacerations

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The obvious finding is a small subconjungtival
hemorrhage
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Subconjunctival hemorrhage may be spontaneous or the
result of trauma. In this patient, the hemorrhage was
spontaneous.
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Limbal foreign bodies
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Corneal foreign bodies
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A B

A.Corneal abrasion stained with fluorescein and

illuminated with white light
B.Corneal abrasion stained with fluorescein and
illuminated with blue light 23
Subtarsal foreign body
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 Lower lid gently pulled down to show a
conjunctival foreign body. The cornea has also
been perforated 25
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 Chemical Injuries
• Acids
– Sulfuric (H2SO4) - Hydrochloric (HCl)
– Sulfurous (H2SO3) - Chromic (Cr2O3)
– Acetic (CH3COOH)

• Alkalies
– Ammonia (NH3) - Mg(OH)2
– Lye (NaOH) - Ca(OH)2
– Potassium hydroxide (KOH)
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 Chemical Injuries cont..
• Chemical injuries are a true ocular emergencies

• The amount of tissue damage is directly related

to the length of time the chemical remains in
contact with the eye

• Immediate irrigation is vital

• Chemical composition is also important

• Alkaline agent tend to penetrate the eye than
acids 31
 A B
A. Severe alkali injury
B. Acid injury caused by exploding car baterry

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 Grade I chemical injury :clinical appearance. Epithelial
defect involving one quadrant without significant limbal
ischemia or evidence of limbal stem cell loss
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 Grade II chemical injury : clinical appearance. In the
quadrant with epithelial defect there is obvious limbal
ischemia and probable lpss of limbal stem cells 34
 Management of chemical injury

• Copious irrigation and meticulous removal of all

chemical residues

• Irrigating fluid should reached the conjunctival

fornices

• Continued until the pH of the eye normalized

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 Management of chemical injury
cont....

• Antibiotic ointment 4 times daily

• Cycloplegic
• Topical steroid (first 7-10 days)
• 10% ascorbat drops every 2 hours
• 10% citrate drops every 2 hours
• High-dose vitamin C (500 mg orally 4x daily)
• If IOP high used aqueous supressant

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 5.2. Closed Globe Injuries: Anterior
chamber

• Traumatic mydriasis and spasm of

accomodation
• Traumatic iritis
• Iris sphincter tears and iridodialysis
• Hyphema
• Angle recession
• Cyclodialysis

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Traumatic mydriasis
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Iridodialysis 43
Rebleeding in patient with traumatic hyphema.
Note fresh red blood layered over dark clot
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 Management of Hyphema

1. Topical prednisolone acetate 1% 4x daily

2. Cycloplegia is maintained with atropine
3. Worn eye shield full-time
4. Maintain bed rest with minimal ambulatory
5. Keep the head of their be angled at more than
45 degrees
6. Warning sign of rebleeding and elevated IOP
7. Daily follow-up

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 Criteria of surgical intervention on
hyphema

• Microscopic corneal blood staining

• Total hyphema with IOP 50 mmHg or > 5 days

• Total hyphema doesn’t resolve below 50% st 6

days with IOP of 25 mmHg or more

• Hyphema that remains unresolved for 9 days

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 5.3. Closed Globe Injuries: Lens

• Lens subluxation and dislocation

• Phacoanaphylactic uveitis
• Lens-induced glaucoma

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Lens subluxation and dislocation
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Anterior dislocation of the lens
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Lens-induced glaucoma
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5.4. Closed Globe Injuries: Posterior
segment

• Commotio retinae
• Traumatic vitreous hemorrhage
• Traumatic macular hole
• Choroidal rupture
• Suprachoroidal hemorrhage
• Traumatic retinal detachment

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Traumatic vitreous haemorrhage
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Traumatic macular hole
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Retinal detachment
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 Scleral coat

Detached retina

Traction on retina

Vascular choroid

Retinal detachment. Only visible on direct

ophthalmoscopy when detachment is advanced
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 5.5.Closed Globe Injuries: Eyelid
laceration

• Non-marginal eyelid lacerations

• Marginal eyelid lacerations
• Canalicular lacerations

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 • Marginal superior eyelid lacerations
• Non-marginal inferior eyelid lacerations
• Superior canalicular lacerations
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 5.6.Closed Globe Injuries: Orbital
trauma
• Orbital blowout fractures
• Intraorbital foreign bodies
• Traumatic optic neuropathy
• Orbital hemorrhage and compartement
syndrome
• Traumatic extraocular muscle injury

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Shuttlecocks and squash balls fit neatly inside the
orbital rim – hence potential for severe injury to
the globe – larger objects such as footballs hit
the orbital rim first.
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Signs of a left orbital blowout fracture (patient
looking upwards)
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Radiograph showing blowout fracture of the left
orbit with fluid in the maxillary sinus
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 6. Open Globe Injuries

• Ruptures and Lacerations

– Rupture: a full-thickness eye wall wound caused by a

blunt object
– Laceration: a full-thickness eye wall wound caused by
a sharp object

• Intraocular Foreign Body

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 6.1. Open Globe Injury: Rupture
• A full-thickness eye wall wound caused by a
blunt object

Extensive subconjungtival hemorrhage due to trauma. The

examiner needs to consider the possibility of globe
rupture or laceration
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6.2. Open Globe Injury: Penetrating

Scleral Penetrating injury

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 7. Prevention of eye injuries

• Work-related injuries
• Sport injuries
• Airbag injuries
• Assault-injuries

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