ocular trauma slide
TRANSCRIPT
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Ocular TraumaOcular Trauma
Dr. Devi Handayani Putri, SpMDr. Devi Handayani Putri, SpM
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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
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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.
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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
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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
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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
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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
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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
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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
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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
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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
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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
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Hyphema Hyphema
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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
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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.
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HemosiderosisHemosiderosis
cornea becomes stained by bloodcornea becomes stained by blood prolonged hyphemaprolonged hyphema
elevated IOPelevated IOP
endothelial damage endothelial damage
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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
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Traumatic cataractTraumatic cataract
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Lens subluxationLens subluxation
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Anterior Lens DislocationAnterior Lens Dislocation
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Posterior Lens DislocationPosterior Lens Dislocation
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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
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Intra Orbital Foreign BodyIntra Orbital Foreign Body
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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
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Globe RuptureGlobe Rupture
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Retrobulbar hemorrhageRetrobulbar hemorrhage
OOrbital vessel ruptures and leaks blood products rbital vessel ruptures and leaks blood products
into the orbitinto the orbit
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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
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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
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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. .
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Low-Flow Arteriovenous fistulaLow-Flow Arteriovenous fistula
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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
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A medial wall or ethmoidal fractureA medial wall or ethmoidal fracture
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Blow-out fractureBlow-out fracture
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Tripod fractureTripod fracture
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Orbital roof fractureOrbital roof fracture
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Vitreous And Retinal Conditions That Vitreous And Retinal Conditions That Can Be Caused By TraumaCan Be Caused By Trauma
Intraocular foreign bodyIntraocular foreign body
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Commotio retinaeCommotio retinae / Berlin’s Edema/ Berlin’s Edema
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Pre-retinal hemorrhagePre-retinal hemorrhage
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Choroidal ruptureChoroidal rupture
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Traumatic macular holeTraumatic macular hole
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Purtscher's retinopathyPurtscher's retinopathy
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•Traumatic Retinal detachmentTraumatic Retinal detachment
Traumatic retinal detachmentTraumatic retinal detachment
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Traumatic optic neuropathyTraumatic optic neuropathy
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Optic nerve avulsionOptic nerve avulsion
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Thank YouThank You