Ocular Trauma

Dr. Devi Handayani Putri, SpM

Introduction
Pathophysiology

coup :directly contrecoup :shock-wave that is imparted by the coup equatorial expansion : global repositioning.

Classification

closed open globe injuries

Examination

History
the details of the trauma, pre-injury vision, previous ocular surgery, medical history, current medications, and allergies.

Visual acuity

Pupillary testing Extra-ocular motilities (EOMs) Confrontation visual fields Eyelids and orbital margins should be palpated Forehead and cheek sensitivity should be evaluated.

Refractive and Adnexa Conditions That Can Be Caused by Trauma

Traumatic myopia Transient myopia that can occur after blunt ocular trauma Traumatic myopia tends to resolve without treatment Periorbital ecchymosis "black eye," blood accumulation in the eyelids,more noticeable in the lower lid , forms an organized hematoma or firm purplish-black mass

Treatment cold compress intermittently for the first 48 hours, followed by hot packs for 3 to 5 days thereafter

Eyelid lacerations Superficial lacerations : clean the wound, irrigate, remove any foreign material, apply AB ointment and sterile dressing Deeper lacerations : sutures Complicated lacerations : oculoplastics consult

Anterior Segment Conditions That Can Be Caused by Trauma

Subconjunctival hemorrhages do not require treatment, resolve in 1 to 2 weeks

Conjunctival abrasions -Produce fluorescein staining, subconjunctival hemorrhage -AB eo TID for 4 to 7 days, pressure patching for 24 hours -Suturing, heal without surgical repair

Corneal and conjunctival foreign bodies asymptomatic, mild to moderate eye pain inspect the fornices thoroughly and evert the eyelids

Corneal abrasions Seidel test History of rubbing or scraping the cornea Treatment Small to moderately: fairly tight-fitting bandage lens + AB Large abrasions : pressure patch + AB Cycloplegics and analgesic

Corneal laceration Cutting or tearing the cornea Seidel test can be crucial Partial-thickness : treat like a corneal abrasion

Moderate to deep :

suturing

Full-thickness : treat like a ruptured globe Moderate and Full - Ophthalmologist

Chemical burns Affect multiple ocular structures,potentially cause blindness Alkaline : hydrophilic and lipophilic

rapidly penetrate cell membranes

saponification,cell death disruption of the extracellular matrix

Acidic : less damage , coagulated tissue Whiter eyes are more alarming then red eyes Management : begin irrigation as soon as possible cycloplegic, AB eo, artificial tears, steroid topical, oral Vit C , Diamox, pressure, amnion membran

Hyphema

Layering of RBCs in the inferior anterior chamber Management : Hospitalization during the most critical time for clot formation; about 5 to 7 days after the injury. Discontinuing elective anticoagulants Patient's head should be elevated 30 Antifibrinolytic agent, steroids

Surgical evacuation of the clot

Complication 3.5 to 38% of patients rebleed, 2 to 5 days after about 30% have temporarily elevated IOP for 5 to 7 days 5% require surgical intervention about 75% demonstrate some degree of angle recession or iridodialysis only 5% will develop secondary glaucoma.

Hemosiderosis

cornea becomes stained by blood

prolonged hyphema elevated IOP endothelial damage

Iridodialysis Detachment of the iris root from the ciliary body Produce corectopia (irregular pupil shape), pseudo polycoria, and diplopia Monitor for glaucoma Treatment :opaque soft contact lens with a clear pupil

Traumatic cataract

Lens subluxation

Anterior Lens Dislocation

Posterior Lens Dislocation

Globe And Orbit Conditions That Can Be Caused By Trauma

Intraorbital foreign body High-velocity periocular injuries Inorganic IOFBs and Organic Anti-tetanus prophylaxis and a broad-spectrum oral antibiotic
Surgical removal is indicated

Intra Orbital Foreign Body

Globe Rupture

Globe rupture The signs Severe subconjunctival hemorrhage Deep or shallow anterior chamber, hyphema, irregularly shaped pupil , exposed uveal tissue (appears brownish-red), an EOM restriction ,hypotony Management Suture, Eviseration

Globe Rupture

Retrobulbar hemorrhage Orbital vessel ruptures and leaks blood products into the orbit

The sign non-pulsating exophthalmos resistance to retropulsion, elevated IOP EOM restriction, central retinal artery pulsation, choroidal folds, and possibly optic neuropathy Treatment Decrease IOP Immediate surgical lateral canthotomy and cantholysis to reduce orbital pressure Orbital decompression

Arteriovenous fistulas

High-flow fistulas : traumatic basal skull fracture

The Signs audible orbital bruit, pulsatile proptosis, chemosis, orbital swelling, elevated IOP, ophthalmoplegia, and retinal vessel congestion

Low-flow fistula Insidious onset , not usually caused by trauma associated with hypertension , arteriosclerosis

The signs Mild orbital congestion , proptosis, low or no

orbital bruit, and normal to elevated IOP.

Low-Flow Arteriovenous fistula

Orbital fractures

Common cause :
The signs

Blunt trauma

Crepitus or subcutaneous emphysema Muscle entrapment and/or a nerve palsy , decrease facial sensitivity

A medial wall or ethmoidal fracture

Blow-out fracture

Tripod fracture

Orbital roof fracture

Vitreous And Retinal Conditions That Can Be Caused By Trauma

Intraocular foreign body

Commotio retinae / Berlins Edema

Pre-retinal hemorrhage

Choroidal rupture

Traumatic macular hole

Purtscher's retinopathy

Traumatic Retinal detachment

Traumatic retinal detachment

Traumatic optic neuropathy

Optic nerve avulsion

Thank You