OCULAR TRAUMA AND

EMERGENCY
NADA YULIANDHA
I 111 11 040

A. Eye Emergency

True emergency (in minutes)

Blindness thread : alkalis chemical injury
Urgent case (in couple hours)
Eyelid laceration, conjungtivitis, GO, corneal
erotion, corneal laceration, corneal foreign
bodies, corneal ulcus, hyphema, acute
congestif glaucoma, retina detachment,
blunt trauma, radiation
Mild emergency (in days or week)
Vitamin A deficiency, congenital cataract

B. Mechanism of Injury
BETTs Classification
Closed-globe Injury
Without injury to the whole wall (corneal & sclera)
- Contusio
- Lamellar laceration
2. Open-globe Injury
With injury to the whole layer of corneal or sclera,
or both
- Rupture
- Laceration (penetrans, perforans, intraocular
foreign-body)
1.

B. Mechanism of Injury
BETTs Classification

B. Mechanism of Injury
1.
2.
3.
4.

Mechanical trauma (blunt & incisive)

Penetrating ocular trauma
Chemical trauma (alkalis & acid)
Radiation trauma

B1. Mechanical Trauma

Eyelid
Eyelid hematoma : highly vascularized
and swelling under the eyelid due to
ruptured vascular
Brill hematoma : deeper bleeding (urgent)
Ruptured artery oftalmica Fracture
basis cranii blood flows into orbita
Palpebra
cavity
hematoma
Treatment

Stop bleeding & relieve pain : compress

Anti inflammation : steroid/NSAID

B1. Mechanical Trauma

Eyelid
In eyelid blunt trauma, laceration can
also occurs. With or without severe
edema
Treatment :

Palpebra
laceration

Close wound : perform

hecting, eye patch
If edema occurs, perform
hecting after edema
reduces : keep it clean
and cover with wet eye
patch

B1. Mechanical Trauma

Conjungtiva
Edema conjungtiva
Treatment :
Mild prevents fluid
accumulation : dekongestan
Severe fluid insition
Chemotic
conjungtiva

B1. Mechanical Trauma

Conjungtiva
Hematoma subconjungtiva
Ruptured artery conjungtiva & episclera
Spontan : age, persistent cough,
hipertension, haemorragic conjungtivitis,
anemia,
Traumatic : direct or indiriect
Caution : ruptured (AV , IOP )
Treatment :
Stop bleeding : cold compress
Anti inflammation
Hematoma

B1. Mechanical Trauma

Corneal blunt trauma
Corneal edema
Manifestations : decreased axis visual, halo in
sight, turbid cornea, placido (+)
Treatment :
Hipertonic : NaCl 5%
Glucose
Albumin
In increased IOP : Acetozolamid
Analgetic
Soft lens : pressing cornea reduces
edema better visual axis

B1. Mechanical Trauma

Corneal blunt trauma
Corneal erosion
Manifestations : painful and watery,
photophobia, decreased visual axis
Fluorescein sodium dye : reveals corneal
defect (+) turns green
Treatment :
Local antibiotic broad spectrum
Cycloplegic short-action
Eye patch (24 hours)
Wide range : use soft lens

B1. Mechanical Trauma

Corneal blunt trauma

Corneal erosion

Corneal erosion with

fluoroscein (+)

B1. Mechanical Trauma

Lens blunt trauma
Corneal laceration
Manifestations : painful, watery,
fotophobia, decreased visual axis,
ruptured cornea, wide increased
Condition based on wide & depth :
- hyphema
- prolapse iris
- broken lens
- prolapse mirror body

B1. Mechanical Trauma

Corneal blunt trauma
Lens dislocation
Zonula Zinn detachment abrupts lens
position VA
Lens subluctation
Some parts detachment of zonula Zinn
lens dislocation loses grip
irreversible convex lens myopia
iris been pushed closed angle COA
secondary glaucoma

B1. Mechanical Trauma

Corneal blunt trauma
Anterior

Lens luctation

Zonula Zinn
around the
detachment
equator
into COA
Fallen lens
Suddenly VA,
Complaints
painful, vomit,
blepharospasm
red eye
Posbble causes
Acute
congestive
glaukoma

Posterior
at the whole
circumference
Mirror body
Scotoma in visual
field, aphakia
signs (+12.0D to
farsighted vision
Phacolytic
glaukoma,
phacotoxic
uveitis

B1. Mechanical Trauma

Corneal blunt trauma
Traumatic Cataract
Visible in few days or years
Blunt : lens contusio star form, imprinting
(Vossius ring)
Penetrate : faster reaction, little perforation or
mass in COA

Treatment : based on the time

- toodler : consider ambliopia : primer or
secondary IOL
- no obstacles : wait till eye is calm enough
- with obstacles : lens extraction

B1. Mechanical Trauma

Retina blunt trauma
Retina edema
VA
Greyish retina
Macula edema (Berlin edema) : cherry red
spot (-)
Retina ablatio (retina detachment of choroid)
Predispose : myopia, thin retina
Disturbance of visual field
Funduscopy : greyish retina, lifted & curved
vessels or breaks-off vessels

B1. Mechanical Trauma

Choroid trauma
Choroid ruptured
Subretina haemorrhage
Common site : posterior eye ball,
consentric surrounding papil opticus
Macula lutea : VA
Less visible in haemorrhage condition
White ruptured after blood absorption

B1. Mechanical Trauma

Nervus opticus blunt
trauma
Papil opticus avulsion
Papil opticus detachment
Severe VA blindness
Traumatic optic neuropathy
Nervus opticus compression,
haemorrhage, and edema
Afferent defect reaction on pupil
Treatment : steroid. Fail : Surgical

Blunt Trauma Scheme

B1. Penetrating Ocular

Trauma

Based on the wound depth

Conjungtiva >1cm : hecting
Signs :
- VA
- IOP
- Narrow COA
- Changes in pupils form & location
- Visible ruptured in corneal or sclera
- Prolapse tissue
- Chemotic conjungtiva

B1. Penetrating Ocular

Trauma

Treatment :
- Assuring present of foreign-body
- Topical antibiotic
- Eye patch
- Anti tetanus
- Analgetic
No steroid, too strong patch, ointment

B2. Chemical Injuries

Alkalis is more dangerous than acids

lead to blindness
Incidence : lab accident, industry, argo
business, wars
Factors influenced :
- pH
- early work up
- total concentration

B2. Chemical Injuries

Acids

Material : anorganic, organic (asetat,

forniat), and organic anhidrat (asetat)
In not very low pH self limiting
Process : acid bumps eye immediate
coagulation necrosis prevents
deeper penetrating effect
Severe case : low pH (hydrofluoric acid,
nitric acid) draws water out from
tissue intense heat affects every
layer

B2. Chemical Injuries

Alkalis
Breaks corneal collagen tissue
Liquefactive
Quickly penetrate

B2. Chemical Injuries

Alkalis
THOFT CLASSIFICATION
1st degree : conjungtiva hiperemi +
keratitis pungtate
2nd degree : conjungtiva hiperemi +
corneal epitel detachement
3rd degree : conjungtiva hiperemi +
conjungtiva necrosis + corneal epitel
detachment
4th degree : tissue necrosis 50%

B2. Chemical Injuries

Acids

Alkalis

B2. Chemical Injuries

Manifestations

Subjectif : eye pain, watery, fotophobia

Objectif :
- pericorneal dilatation
- corneal edema
- conjungtiva & sclera necrosis
- fluorescein test

B2. Chemical Injuries

Treatment

Irrigation using saline or Ringer lactate for at

least 15-30 minutes. Tap water can be used
An eyelid speculum and topical anesthetic
pH is checked in the inferior fornix using litmus
paper. Irrigation is continued until neutral pH
Conjunctival fornices should be swept with a
moistened cotton-tipped, especially in
persistently abnormal pH
Alkalis particles easier removed with disodium
ethylenediaminetetraacetic acid (EDTA)
Pain resists bandage

B2. Chemical Injuries

Medications

Pain relief, prevents synekia : Cycloplegic (e.g.,

scopolamine 0.25%). Avoid phenylephrine because of its
vasoconstrictive properties.
Prophylaxis : Topical antibiotic ointment (e.g.,
erythromycin) q12h
Oral pain medication (e.g., acetaminophen) as needed.
Elevated IOP : Acetazolamide (e.g., Diamox) 250 mg p.o.,
q.i.d. Electrolytes, especially potassium, should be
monitored in patients on these medications. Add a
topical beta-blocker (e.g., timolol 0.5% b.i.d.) if
additional IOP control is required.
Frequent (e.g., q1h while awake) use of preservative-free
artificial tears or gel

B2. Chemical Injuries

Acids

B3. Electromagnetic
Radiation Injuries
1.
2.
3.

Infrared
Ultraviolet keratoconjungtivitis (most
common radiation injury)
X-ray and ionizing ray

B3. Electromagnetic
Radiation Injuries
INFRARED
Incidence : starring at solar eclipse,
roastery
Process : full concentrate to absorbed
visible infrared
Treatment : Prevents macula
sicatrics and anti inflammation
(only in occurance of
inflammation) : steroid

B3. Electromagnetic
Radiation Injuries
ULTRAVIOLET
UV keratoconjungtivitis (most common)
Incidence : welding and starring at sun shines
with improper eye protection
Process : immediately breaks corneal epitel
creates signs after 6-8 hours :
- acute blindness
- pain, photophobia, epiphora
- intolerable foreign-body sensation
- blepharospasm

B3. Electromagnetic
Radiation Injuries
ULTRAVIOLET
Objective findings : slit lamp :
- epithelial edema
- superficial punctate keratitis
- palpebral fissure erosion under fluorecein dye
- miosis pupil
- VA
Treatment : (non accumulation : 48 hours recovery)
- Siklopegik
- Local antibiotic
- Analgetic
- Eye patches

B3. Electromagnetic
Radiation Injuries
XRAY & IONIZATION RAY
Sources : alpha, beta, gamma, xray
Ionization radicals in laten period
tissue damage common sites
(lens and retina)
Causes : cataract & retinopathy

B3. Radiation Injuries

Scheme

TERIMA KASIH