LAPORAN KASUS POLIKLINIK

THEORY
 Penetrating

Laceration Perforating
Open
Globe
Injuries Intraocular
Ruptures Foreign Body
Ocular Injury /
Blunt
Trauma
Trauma/Contussion
Closed
Globe Burns
Injury
Lamellar
Laceration

Standarized classification of ocular trauma using trauma eye using the Birmingham Eye Trauma Terminology (BETT) classification (Kuhn et al, 1996)
VN Sukati. Ocular injuries- A Review . S Afr Optom 2012 71(2) 86-94
OCULAR TRAUMA SCORE (OTS)

● Initial vision : 70
● Rupture : 0
● Endophthalmitis : 0
● Perforating injury : -14
● Retinal detachment: 0
● APD : 0
TOTAL : 56  OTS 2

Scott, Robert. The Ocular Trauma Score. https://www.ncbi.nlm.nih.gov/pmc/ articles/PMC4790158/. Community Eye Health. 2015; 28(91): 44–45.
ESTIMATED FOLLOW UP VISUAL
ACUITY CATEGORY AT 6 MONTH
INTRAORBITAL FOREIGN BODY

● Intaorbital foreign bodies (OrbFBs) are common complication of ocular trauma.

Intraocular foreign bodies (IOFBs) are foreign bodies that have pentrated the eye
and lodged within the globe.

● In contrast, Intraorbital foreign bodies (OrbFBs) are lodged within the walls of
the orbit, which create the risk of damage to surrounding structures, such as
extraocular muscles and cranial nerves II through VI

Rowlands, Megan A., Ehrlich, Michael. Management Of Intraorbital Foreign Body. Ophthalmic Pearl Eyenet
Magazine. January 2016; 31-32
INTRAORBITAL FOREIGN BODY

● Intraorbital foreign bodies usually occur after a high-velocity injury such as a

gunshot or industrial accident but may occur after relatively trivial trauma to the
extent that the history may be unclear.

● Inorganic foreign bodies usually cause visual loss or orbital complications from
direct trauma, whereas organic foreign bodies also have a higher incidence of
developing severe orbital infections.

Fulcher, Timothy, et al. Clinical Features and Management of Intraorbital Foreign Bodies. American
Academy of Ophthalmology. Ophthalmology 2002;109:494–500
 CLINICAL ASSESSMENT

● Presentation of OrbFBs can vary but most commonly occur in Males,

aged 11-30 years old

● Signs can vary depending of trauma to the globe  Open or Closed

Globe injury

● Diagnostic Imaging: Plain X-Ray, CT-Scan, or MRI (contraindicated

in suspected metallic foreign body)
TYPE OF FOREIGN BODY
● MOST intraorbital foreign body is metallic, resulting from small particles penetrating the
orbit through high velocity trauma.

● Non metallic OrbFBs include inorganic material  glass, plastic; organic material wood

● Organic Foreign body carry a higher risk of subsequent infection compared to inorganic
material

● However, some metallic , iron, copper, and lead, can cause spesific complication
retinopathy, siderosis, chalcosis, systemic toxicity

Fulcher, Timothy, et al. Clinical Features and Management of Intraorbital Foreign Bodies. American
Academy of Ophthalmology. Ophthalmology 2002;109:494–500
Fulcher, Timothy, et al. Clinical Features and Management of Intraorbital Foreign Bodies. American
Academy of Ophthalmology. Ophthalmology 2002;109:494–500
 MANAGEMENT
Medical Treatment

● After diagnostic evaluation, all patients with OrbFBs should be treated with antitetanus
prophylaxis at presentation.

● If there is a history of recent injury or if signs of orbital infection are present, it is

reasonable to give broad-spectrum antibiotics to cover some of the commonly
implicated pathogens.

● In cases of organic FBs, the clinician should consider additional anaerobic coverage.

Rowlands, Megan A., Ehrlich, Michael. Management Of Intraorbital Foreign Body. Ophthalmic Pearl Eyenet
Magazine. January 2016; 31-32
MANAGEMENT
Surgical Extraction
● In deciding whether to extract the FB, the physician must weigh the risk of surgery against
the risks of retention. Surgical removal is usually attempted for all organic OrbFBs because of
their higher risk of inflammation and infection. The removal of inorganic FBs depends on
their composition, location, and clinical presentation, and the impairment they cause

● If the globe is ruptured, it should be repaired and sealed to prevent loss of contents before
any orbital exploration for OrbFBs.

Rowlands, Megan A., Ehrlich, Michael. Management Of Intraorbital Foreign Body. Ophthalmic Pearl Eyenet
Magazine. January 2016; 31-32
 PROTOCOL MANAGEMENT OrbFBs

Fulcher, Timothy, et al. Clinical Features and Management of Intraorbital Foreign Bodies. American
Academy of Ophthalmology. Ophthalmology 2002;109:494–500
 PROGNOSIS

● The clinical outcome of OrbFBs depends on the severity of the inciting trauma, and the location and
material of the FB. Visual loss typically occurs as a result of the initial injury and will be noted at
presentation.

● Posterior OrbFBs tend to confer a worse visual prognosis because of their association with
traumatic optic neuropathy, while patients with anterior OrbFBs often have at least 20/40 final visual
acuity.
● Organic materials elicit greater inflammatory reactions and increase the risk of endophthalmitis
and cerebral infection.

Rowlands, Megan A., Ehrlich, Michael. Management Of Intraorbital Foreign Body. Ophthalmic Pearl Eyenet
Magazine. January 2016; 31-32
TERIMA
KASIH