Dr. Agus Supartoto (OCULAR TRAUMA Dr. as-Ali 2 Oktober
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Transcript of Dr. Agus Supartoto (OCULAR TRAUMA Dr. as-Ali 2 Oktober
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OCULAR TRAUMA
dr. Agus Supartoto, Sp.M(K)
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1. Introduction
Ocular trauma is a disease with bimodal age
distribution; late of adolescence, early
adulthood, & older than 70.
Severe ocular trauma, vision threatening eyeinjuries, 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. General Medical Evaluation
Non-ocular trauma
Life-threatening injuries
Measuring vital signs and mental status
Immediately transferred to emergency room:
Respiratory distress
Cardiovascular instability Massive bleeding
Acutely impaired mental status
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3.2. 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, orsafety glasses at a time of accident
6. Presence of witnesses to the accident
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3.3. Examination
Visual acuity
Pupils
Brightness testing and color vision
Visual fields Extraocular motility
Intraocular pressure
External examination: head, face, periorbitalarea, eyelid
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3.4. Examination cont
Conjuctiva
Cornea
Anterior chamber Iris
Lens
Vitreous Retina and choroid
Optic nerve
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3.5. 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 andexit wounds
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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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Corneal foreign bodies
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Small metallic foreign bodies have a predilection for thesuperior tarsal conjungtival surface. In this patient a
small fragment of metal is adherent to the conjungtiva
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A B
A.Corneal abrasion stained with fluorescein andilluminated with white light
B.Corneal abrasion stained with fluorescein and
illuminated with blue light
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Subtarsal foreign body
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Lower lid gently pulled down to show a
conjunctival foreign body. The cornea has alsobeen perforated
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Chemical Injuries
Alkalies
Sulfuric (H2SO4) - Hydrochloric (HCl)
Sulfurous (H2SO3) - Chromic (Cr2O3)
Acetic (CH3COOH)
Acids
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 incontact with the eye
Immediate irrigation is vital
Chemical composition is also important
Alkaline agent tend to penetrate the eye thanacids
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A. Severe alkali injury
B. Acid injury caused by exploding car baterry
A B
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Grade I chemical injury :clinical appearance. Epithelialdefect 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 thequadrant with epithelial defect there is obvious limbal
ischemia and probable lpss of limbal stem cells
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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
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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 IOP7. 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 doesnt 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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5.4. Closed Globe Injuries: Posterior
segment
Commotio retinae
Traumatic vitreous hemorrhage
Traumatic macular hole
Choroidal rupture
Suprachoroidal hemorrhage
Sclopetaria
Traumatic retinal detachment
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Traumatic macular hole
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Retinal detachment
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Retinal detachment. Only visible on directophthalmoscopy when detachment is advanced
Scleral coat
Detached retina
Traction on retina
Vascular choroid
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5.5.Closed Globe Injuries: Eyelid
laceration
Non-marginal eyelid lacerations
Marginal eyelid lacerations
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 compartementsyndrome
Traumatic extraocular muscle injury
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Shuttlecocks and squash balls fit neatly inside theorbital rim hence potential for severe injury tothe globe larger objects such as footballs hit
the orbital rim first.
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Signs of a left orbital blowout fracture (patientlooking upwards)
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Radiograph showing blowout fracture of the left
orbit with fluid in the maxillary sinus
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Retained wooden orbital foreign body
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Orbital absess associated with proptosis,restricted extraocular muscle movement, fever,
and malaise
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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 ablunt object
Extensive subconjungtival hemorrhage due to trauma. Theexaminer needs to consider the possibility of globe
rupture or laceration
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6.2. Open Globe Injury: Penetrating
Scleral Penetrating injury
Ocular Trauma Score (OTS): Predicting
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Ocular Trauma Score (OTS): Predicting
the final vision in the injured eye
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7. Prevention of eye injuries
Work-related injuries
Sport injuries
Airbag injuries
Assault-injuries
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Thank You