OCULAR TRAUMA

dr. Rosmaryati Manalu, Sp.M

 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. 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, or
safety 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, periorbital
area, 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 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 19
Corneal foreign bodies
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Small metallic foreign bodies have a predilection for the
superior 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 and

illuminated with white light
B.Corneal abrasion stained with fluorescein and
illuminated with blue light 22
Subtarsal foreign body
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 Lower lid gently pulled down to show a
conjunctival foreign body. The cornea has also
been perforated 24
 Chemical Injuries
Acids
Ammonia (NH3) - Mg(OH)2
Lye (NaOH) - Ca(OH)2
Potassium hydroxide (KOH)
Alkalies
Sulfuric (H2SO4) - Hydrochloric (HCl)
Sulfurous (H2SO3) - Chromic (Cr2O3)
Acetic (CH3COOH)

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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 26
 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 29
 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 34
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 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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Anterior dislocation of the lens
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Lens-induced glaucoma 41
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 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. 50
Signs of a left orbital blowout fracture (patient
looking upwards)
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52
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 a

blunt object

Extensive subconjungtival hemorrhage due to trauma. The

examiner needs to consider the possibility of globe
rupture or laceration 57
6.2. Open Globe Injury: Penetrating

Scleral Penetrating injury

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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

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