OCULAR TRAUMA

Nature of trauma
Domestic
Car accident
Industry
Child
Sport
Military
Criminal
Catastrophe
Diagnostic options
Patient history
Inspection
Ophthalmoscopy
NB! Tetanus Immunization History
Classification ocular trauma
1. Mechanical injuries eyelid, lacrimal system, globe
(penetrating injury, nonpenetrating injury), orbit
2. Chemical injuries acid burns, alkali burns
3. Injuries due to physical agents burns, ionizing radiation,
ultraviolet light
4. Indirect ocular trauma
Eyeglobe injuries
90% corneal and conjunctival foreign bodies
8% burns and chemical injuries
2% penetrating injury
Eyelid injury
Involvement of the eye lid margin
Avulsion of the lacrimal canaliculus
Corneal and conjunctival foreign bodies
Corneal foreign body with ring of rust
Conjuctival foreign body
Parallel corneal striations
Foreign body under the upper eyelid
Foreign body treatment
1. Injection needle manipulation
2. Eversion upper eyelid
3. The corneal defect is carefully clean out with a drill or injection
needle
4. Cotton swab manipulation

Corneal Erosion
1. Linear corneal erosion
2. Recurring erosion
Corneal trauma
1. Foreign-body sensation
2. Epiphora
3. Photophobia
4. Blepharospasm
5. Conjunctival injection
Blunt

ocular trauma (ocular Contusion)

Fist
Golf ball
Champagne cork
Cows horn

Blunt ocular trauma (ocular Contusion)

1.

Iridodialysis
Loss of pupillary roundness
Increased glare
Monocular doubling (in severe cases)
Tx : by suturing

2. Traumatic aniridia
Increase glare and phhotophobia
Tx: by using sunglasses or contact lens or surgery / artificial
iris
3.

Traumatic cyclodialysis (leads to)

Intraocular hypotonia
Choroidal folds
Optic disc edema
Visual impairment
Phthisi oculi ( shrinkage of eyeball )

4.

Subluxation of the lens

Subluxation to the anterior chamber
Subluxation to the posterior chamber
Partial avulsion of the zonule fibers
Tx : removes lens, use artificial lens

5. Avulsion of the ora serrate

Local ora serrate avulsion with after laser hotocoagulation

scars.
Huge ora serata avulsion with subsequent retinal detachment

6.

7.

Sphincter tear and traumatic midriasis

Tx: reduce glare sensation, suture corneal
Contusion rosette
Cataract at anterior surface of lens

8. Vossius ring
Circular ring seen at anterior surface due to epithelium
pigment
No reduction acquity
9. Berlins edeme (commotion retinae)
At photoreceptor layer
Shock cause lose visual acquity
10.
Choroidal ruptures
CR with subretinal hemorrhage
CR around the optic disc
11.
Traumatic sectoral retinochoroidopathy
Avulsion or impingement of the short posterior ciliary arteries.
Usually have a sectoral or triangle like shape
12.
Avulsion of the globe
Blind immediately
13.
Avulsion of the optic nerves
Trauma, minor injury
14.
Injury to the optic nerve (atrophy)
Death of ganglion cell
15.
Retrobulbar hematoma
Eyelid hematoma
Subconjuctival hematoma
Exophthalmos
16.
Hyphema
Blood layering the gravitation
Microhyphema
Tx : allow the blood to settle down, to restore the visual
acquity
17.

Vitreous hemorrhage

Signs of retinal detachment on ultrasound examination (t

shape)
Check thru opthalmoscopy
Tx : spontaneous recession of blood

18.
Orbital fracture (blow out fracture)
Enophthalmos, restriction of upward glaze
Retrobulbar hematoma
Hanging drop of water on ct scan
Tx : decrease double vision by surgery after rotation of eyeball
Absolute signs of open-globe injuries
Presence of foreign body in the eyeball
Visible wound channel
Drop out the content of eyeball, from lose at all to visual
acquity ;1
Relative signs of open-globe injuries
Small or absent anterior chamber
Pupil displaced toward the penetration site
Traumatic cataract
Hypotonia of globe
Hyphema and hemophthalmos
Additional diagnostic imaging studies
1.Radiography
2.Ct studies
First aid if OGI suspected
1. Tetanus immunization or prophylaxis and prophylactic
antibiotics tx
2. Sterile binocular bandage, hospitalization supine
Surgical treatment of penetrating injuries
1. Vitrectomy and extraction of the foreihn body
2. Corneal suturing
3. Invaginating silicone transplant
Late

sequelae OGI
2ndary angle closure glaucoma
retinal detachment
siderosis and chalcosis (sign : Kayser-Fleischer ring, Posterior
subscapular sunflower shaped cataract)
iridocyclitis and endophthalmitis
sympathic ophthalmitis

Chemical Injuries
Acid burns

Alkali burns

Primary symptoms
Epiphora
Blepharospasm
Severe pain
Slight eye burn
Cornea s/f punctate keratitis but no any corneal erosion.
Stroma is intact.
Conjunctiva conjunctival epithelium largely intact but
presence of slight chemosis (edematous conjuctival swelling)
and irritation.
No any intraocular involvement
Prognosis is good. Healing w/out loss of fx
Moderate to severe eye burn (white eye burn, symblepharon)
Cornea moderate to total corneal erosion, slightly upper
layers stroma opacification.
Conjunctiva - moderate chemosis and segmental ischemia of
the limbal vessels (white chemosis)
Some intraocular damage slight irritation of the anterior
chamber (slight amount of cellular and protein exudate in the
anterior chamber)
Prognosis : defect healing w functional impairment and
possibly symblepharon
Severe eye burn (cooked fish eye)
Cornea - total corneal erosion including erosion of the
conjuctival epithelium at the limbus. All layers of stroma are
opacified (crooked fish eye)
Conjunctiva sevete chemosis, total ischemia of the limbal
vesels
Severe intraocular damage severe irritation of the anterior
chamber, damage to the iris, lens, ciliary body, and angle of
the anterior chamber.
Prognosis poor defect healing w functional impairment that
may include loss of the eye as an organ. Symblepharon.
First aid w the chemical burn.
NV! Immediate rich irrigation o the eyes
First ophthalmological aid
Treatment by the ophthalmologist or the eye clinic;
Administer topical anesthesia to relieve pain and neutralize
blepharospasm

Revision of conjuctival sac

Wash the eye with a buffer solution
Initiate systemic paim therapy if indicated
Tetanus immunization or prophylaxis
Hospitalization

Treatment in the hospital

Continue irrigation
Initiate topical cortisone therapy
Asminister subconjuctival steroids
Immobilize the pupil
Oral anti-inflammatory agents
Administer oral and topical vitawin C to neutralize cytotoxic
raducals
Administer 500mg of oral acetazolamide (Diamox) to reduce
intraocular pressure as prophylaxis against secondary
glaucoma
Administer hyaluronic acid for corneal care to promote reepitheliazation and stabilize the physiologic barrier
Administer topical antibiotic eyedrops
Carry out debridement of necrotic conjuctival and corneal
tissue and make radial incisions in the conjunctiva (Passows
method) to drain the subconjunctival edema.
Additional surgical treatment in the presence of impaired wound
healing following extremely severe chemical injuries:
A conjuctival and limbal transplantation
Cyanoacrylate glue attaching a hard contact lens
A tenons capsuloplasty
Late

surgical treatment after the eye has stabilized

Lysis of symblepharon
Plastic surgery of the eyelids to release the globe
Transplantation of nasal mucosa
Penetrating keratoplasty
Keratoprosthetics
Glaucoma surgery

Ultraviolet keratoconjunctivitis or electro-ophthalmia

Antibiotic ointment tx for 1-2 days
Thermal Burns
Tx: aseptic bandage. Atrophic aesthetic
Radiation Injuries