ocular trauma slide

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Ocular Trauma Ocular Trauma Dr. Devi Handayani Putri, SpM Dr. Devi Handayani Putri, SpM

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Page 1: Ocular Trauma Slide

Ocular TraumaOcular Trauma

Dr. Devi Handayani Putri, SpMDr. Devi Handayani Putri, SpM

Page 2: Ocular Trauma Slide

IntroductionIntroduction

PathophysiologyPathophysiology coup coup ::directlydirectly contrecoup contrecoup ::shock-wave that is imparted by the shock-wave that is imparted by the

coup coup equatorial expansionequatorial expansion : : global repositioning. global repositioning.

ClassificationClassification closed closed open globe injuries open globe injuries

Page 3: Ocular Trauma Slide
Page 4: Ocular Trauma Slide

ExaminationExamination HHistory istory

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

Visual acuityVisual acuity PPupillary testingupillary testing EExtra-ocular motilities (EOMs)xtra-ocular motilities (EOMs) CConfrontation visual fieldsonfrontation visual fields EEyelids and orbital margins should be palpatedyelids and orbital margins should be palpated FForehead and cheek sensitivity should be evaluated. orehead and cheek sensitivity should be evaluated.

Page 5: Ocular Trauma Slide

Refractive and Adnexa Conditions That Refractive and Adnexa Conditions That Can Be Caused by TraumaCan Be Caused by Trauma

Traumatic myopiaTraumatic myopia

TTransient myopia that can occur after blunt ransient myopia that can occur after blunt ocular trauma ocular trauma

Traumatic myopia tends to resolve without Traumatic myopia tends to resolve without treatmenttreatment

Periorbital ecchymosis "black eye," Periorbital ecchymosis "black eye,"

blood accumulation in the eyelidsblood accumulation in the eyelids,,more more noticeable in the lower lid noticeable in the lower lid ,, forms an organized forms an organized hematoma or firm purplish-black mass hematoma or firm purplish-black mass

Page 6: Ocular Trauma Slide
Page 7: Ocular Trauma Slide

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

Eyelid lacerationsEyelid lacerations

SSuperficial lacerationsuperficial lacerations : : clean the woundclean the wound,, irrigate irrigate,, remove any foreign materialremove any foreign material,, apply apply ABAB ointment ointment and sterile dressingand sterile dressingDDeeper lacerationseeper lacerations : : sutures suturesCComplicated lacerationsomplicated lacerations :: oculoplastics consult oculoplastics consult

Page 8: Ocular Trauma Slide
Page 9: Ocular Trauma Slide

Anterior Segment Conditions That Can Anterior Segment Conditions That Can Be Caused by TraumaBe Caused by Trauma

Subconjunctival hemorrhages Subconjunctival hemorrhages

do not require treatmentdo not require treatment,, resolve in 1 to 2 weeks resolve in 1 to 2 weeks

Page 10: Ocular Trauma Slide

Conjunctival abrasionsConjunctival abrasions

-P-Produce fluorescein stainingroduce fluorescein staining, , subconjunctivalsubconjunctival hemorrhagehemorrhage

-AB eo-AB eo TID for 4 to 7 days TID for 4 to 7 days, , pressure patching for pressure patching for 24 hours 24 hours

-S-Suturing, heal without surgical repairuturing, heal without surgical repair

Page 11: Ocular Trauma Slide

Corneal and conjunctival foreign bodiesCorneal and conjunctival foreign bodies

asymptomaticasymptomatic, , mild to moderate eye painmild to moderate eye pain

inspect the fornices thoroughly and evert the inspect the fornices thoroughly and evert the eyelids eyelids

Page 12: Ocular Trauma Slide

Corneal abrasionsCorneal abrasions

Seidel test Seidel test --

HHistory of rubbing or scraping the cornea istory of rubbing or scraping the cornea

TreatmentTreatment

SSmall to moderatelymall to moderately:: fairly tight-fitting bandage fairly tight-fitting bandage lens + ABlens + AB LLarge abrasionsarge abrasions : : pressure patchpressure patch + AB+ AB

CCycloplegycloplegics andics and analgesic analgesic

Page 13: Ocular Trauma Slide
Page 14: Ocular Trauma Slide

Corneal lacerationCorneal laceration

CCutting or tearing the cornea utting or tearing the cornea

Seidel test can be crucialSeidel test can be crucial PPartial-thickness artial-thickness : : treat like a corneal abrasion treat like a corneal abrasion

MModerate to deepoderate to deep :: suturing suturing

FFull-thicknessull-thickness :: treat like a ruptured globe treat like a ruptured globe

Moderate and Full -Moderate and Full - Ophthalmologist Ophthalmologist

Page 15: Ocular Trauma Slide

Chemical burnsChemical burns

AAffect multiple ocular structuresffect multiple ocular structures,p,potentially cause otentially cause

blindnessblindness

Alkaline : Alkaline : hydrophilic and lipophilichydrophilic and lipophilic

rapidly penetrate cell membranesrapidly penetrate cell membranes

saponificationsaponification,,cell death cell death

disruption of the extracellular matrixdisruption of the extracellular matrix

Page 16: Ocular Trauma Slide

Acidic Acidic :: less damage less damage , , coagulated tissue coagulated tissue

WWhiter eyes are more alarming then red hiter eyes are more alarming then red eyeseyes

Management :Management :

begin irrigation as soon as possiblebegin irrigation as soon as possible

cycloplegcycloplegic, AB eo, artificial tears, steroid topical, ic, AB eo, artificial tears, steroid topical, oraloral

Vit CVit C , Diamox, pressure, amnion membran, Diamox, pressure, amnion membran

Page 17: Ocular Trauma Slide

Hyphema Hyphema

Page 18: Ocular Trauma Slide

LLayering of RBCs in the inferior anterior chamber ayering of RBCs in the inferior anterior chamber

Management : Management :

HHospitalization during the most critical time for ospitalization during the most critical time for clot formation; about 5 to 7 days after the injury. clot formation; about 5 to 7 days after the injury.

DDiscontinuing elective anticoagulants iscontinuing elective anticoagulants

PPatient's head should be elevated 30°atient's head should be elevated 30°

AAntifibrinolytic agentntifibrinolytic agent,, steroids steroids SSurgical evacuation of the clot urgical evacuation of the clot

Page 19: Ocular Trauma Slide

ComplicationComplication 3.5 to 38% of patients rebleed, 2 to 5 days after 3.5 to 38% of patients rebleed, 2 to 5 days after about 30% have temporarily elevated IOP for 5 to about 30% have temporarily elevated IOP for 5 to

7 days7 days 5% require surgical intervention5% require surgical intervention about 75% demonstrate some degree of angle about 75% demonstrate some degree of angle

recession or iridodialysisrecession or iridodialysis only 5% will develop secondary glaucoma.only 5% will develop secondary glaucoma.

Page 20: Ocular Trauma Slide

HemosiderosisHemosiderosis

cornea becomes stained by bloodcornea becomes stained by blood prolonged hyphemaprolonged hyphema

elevated IOPelevated IOP

endothelial damage endothelial damage

Page 21: Ocular Trauma Slide

IridodialysisIridodialysis

DDetachment of the iris root from the ciliary body etachment of the iris root from the ciliary body

PProduce corectopia (irregular pupil shape)roduce corectopia (irregular pupil shape), ,

pseudpseudo o polycoria, and diplopiapolycoria, and diplopia MMonitor for glaucoma onitor for glaucoma

Treatment :Treatment :opaque soft contact lens with a clear opaque soft contact lens with a clear pupil pupil

Page 22: Ocular Trauma Slide

Traumatic cataractTraumatic cataract

Page 23: Ocular Trauma Slide

Lens subluxationLens subluxation

Page 24: Ocular Trauma Slide

Anterior Lens DislocationAnterior Lens Dislocation

Page 25: Ocular Trauma Slide

Posterior Lens DislocationPosterior Lens Dislocation

Page 26: Ocular Trauma Slide

Globe And Orbit Conditions That Can Be Globe And Orbit Conditions That Can Be Caused By TraumaCaused By Trauma

Intraorbital foreign bodyIntraorbital foreign body

HHigh-velocity periocular injuries igh-velocity periocular injuries

IInorganic IOFBs norganic IOFBs and Organicand Organic

AAnti-tetanus prophylaxis and a broad-spectrum nti-tetanus prophylaxis and a broad-spectrum oral antibiotic oral antibiotic

Surgical removal is indicatedSurgical removal is indicated

Page 27: Ocular Trauma Slide

Intra Orbital Foreign BodyIntra Orbital Foreign Body

Page 28: Ocular Trauma Slide

Globe RuptureGlobe Rupture

Globe ruptureGlobe rupture

The signsThe signs

SSevere subconjunctival hemorrhageevere subconjunctival hemorrhage

DDeep or shallow anterior chamber, hyphema, eep or shallow anterior chamber, hyphema, irregularly shaped pupil , exposed uveal tissue irregularly shaped pupil , exposed uveal tissue (appears brownish-red), an EOM (appears brownish-red), an EOM restriction restriction ,,hypotonyhypotony

ManagementManagement

Suture, EviserationSuture, Eviseration

Page 29: Ocular Trauma Slide

Globe RuptureGlobe Rupture

Page 30: Ocular Trauma Slide

Retrobulbar hemorrhageRetrobulbar hemorrhage

OOrbital vessel ruptures and leaks blood products rbital vessel ruptures and leaks blood products

into the orbitinto the orbit

Page 31: Ocular Trauma Slide

The signThe sign non-pulsating exophthalmos non-pulsating exophthalmos resistance to retropulsion, elevated IOPresistance to retropulsion, elevated IOPEOM restriction, central retinal artery pulsationEOM restriction, central retinal artery pulsation,, choroidal folds, and possibly optic neuropathy choroidal folds, and possibly optic neuropathy TTreatmentreatment

DecreaseDecrease IOP IOP

IImmediate surgical lateral canthotomy and mmediate surgical lateral canthotomy and cantholysis to reduce orbital pressurecantholysis to reduce orbital pressure OOrbital decompression rbital decompression

Page 32: Ocular Trauma Slide

Arteriovenous fistulasArteriovenous fistulas HHigh-flow fistulas igh-flow fistulas : : traumatic basal skull fracture

The SignsThe Signs

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

Page 33: Ocular Trauma Slide

LLow-flow fistulaow-flow fistula

IInsidious onset nsidious onset ,, not usually caused by trauma not usually caused by trauma

associated with hypertension associated with hypertension ,, arteriosclerosis arteriosclerosis

The signsThe signs

MMild orbital congestion , proptosis, low or no ild orbital congestion , proptosis, low or no

orbital bruit, and normal to elevated IOPorbital bruit, and normal to elevated IOP. .

Page 34: Ocular Trauma Slide

Low-Flow Arteriovenous fistulaLow-Flow Arteriovenous fistula

Page 35: Ocular Trauma Slide

Orbital fracturesOrbital fractures

Common causeCommon cause :: BBlunt traumalunt trauma The signsThe signs

CCrepitus or subcutaneous emphysemarepitus or subcutaneous emphysema

MMuscle entrapment and/or a nerve palsy uscle entrapment and/or a nerve palsy , ,

decrease facial decrease facial sensitivitysensitivity

Page 36: Ocular Trauma Slide

A medial wall or ethmoidal fractureA medial wall or ethmoidal fracture

Page 37: Ocular Trauma Slide

Blow-out fractureBlow-out fracture

Page 38: Ocular Trauma Slide

Tripod fractureTripod fracture

Page 39: Ocular Trauma Slide

Orbital roof fractureOrbital roof fracture

Page 40: Ocular Trauma Slide

Vitreous And Retinal Conditions That Vitreous And Retinal Conditions That Can Be Caused By TraumaCan Be Caused By Trauma

Intraocular foreign bodyIntraocular foreign body

Page 41: Ocular Trauma Slide

Commotio retinaeCommotio retinae / Berlin’s Edema/ Berlin’s Edema

Page 42: Ocular Trauma Slide

Pre-retinal hemorrhagePre-retinal hemorrhage

Page 43: Ocular Trauma Slide

Choroidal ruptureChoroidal rupture

Page 44: Ocular Trauma Slide

Traumatic macular holeTraumatic macular hole

Page 45: Ocular Trauma Slide

Purtscher's retinopathyPurtscher's retinopathy

Page 46: Ocular Trauma Slide

•Traumatic Retinal detachmentTraumatic Retinal detachment

Traumatic retinal detachmentTraumatic retinal detachment

Page 47: Ocular Trauma Slide

Traumatic optic neuropathyTraumatic optic neuropathy

Page 48: Ocular Trauma Slide

Optic nerve avulsionOptic nerve avulsion

Page 49: Ocular Trauma Slide

Thank YouThank You