TRAUMA

dr.Nurcahya Ardian Bramantha,SpM

 TRAUMA MEKANIS
TRAUMA TAJAM : TRAUMA TUMPUL :
- Penetran - Perforasi
- Non penetran - Non perforasi

Melibatkan
Dinding orbita
 TRAUMA TAJAM
Non Penetran

Laserasi
- Palpebra
- Konjungtiva

Luka lamelar
- Kornea
- Sklera
Putusnya otot-otot ekstra okuler
 TRAUMA TAJAM
Penetran
Ruptur
Kornea / Sklera
Sering disertai :
- Penurunan VISUS
- Khemosis, Ekhimosis
- Prolaps Isis Bola Mata : Iris , Lensa, Korpus Vitrium,
Khoroid
KOA :
Dangkal, Hifema
Lensa : Katarak (katarak traumatika),
Ruptur Lensa
PROLAPS CV
 TRAUMA TUMPUL
NON PERFORASI
1. Palpebra Hematom
2. Konjungtiva Khemosis
3. Kornea Erosi
4. COA Hifema
5. Iris Iridoreksis, Iridodialisis
6. Lensa Luksasi, Sub Luksasi
7. Korpus Vitreum perdarahan (Hemoftalmus)
8. Retina Ablasio
9. Bola Mata Eksoftamus, Enoftalmus

Kerusakan dinding orbita Blow out fraktur

PERFORASI
Prolap isi bola mata
Sembuh Ptisis-bulbi.
 BLOW OUT FRACTURE

Orbital floor fractures :

1. Direct fractures (Unpure Blowout fractur)

2. Indirect fractures (Pure Blowout fractur)

 Eyelid haematoma
Usually innocuous but exclude associated trauma to globe or orbit

Orbital roof fracture if associated with Basal skull fracture - bilateral ring
subconjunctival haemorrhage without haematomas (panda eyes)
visible posterior limit
 Lid margin laceration
Carefully align to prevent notching

Align with 6-0 black silk Close tarsal plate with

suture fine absorbable suture

Place additional marginal Close skin with multiple

silk sutures interrupted 6-0 black
silk sutures
 Canalicular laceration

Repair within 24 hours Locate and approximate ends of laceration

Bridge defect with silicone tubing
Leave in situ for about 3 months
Pathogenesis of orbital floor blow-out fracture
 Signs of orbital floor blow-out fracture

Periocular ecchymosis Ophthalmoplegia - Enophthalmos - if severe

and oedema typically in up- and down-
Infraorbital nerve gaze (double diplopia)
anaesthesia
Investigations of orbital floor blow-out fracture
Coronal CT scan Hess test

Right blow-out fracture with Restriction of right upgaze and downgaze

tear-drop sign Secondary overaction of left eye
 Surgical treatment of blow-out fracture
a b

c d

(a) Subciliary incision Coronal CT scan following repair of

right blow-out fracture with synthetic
(b) Periosteum elevated and entrapped material
orbital contents freed
(c) Defect repaired with synthetic material
(d) Periosteum sutured
 Medial wall blow-out fracture
Signs

Periorbital subcutaneous emphysema Ophthalmoplegia - adduction and abduction

if medial rectus muscle is entrapped

Treatment
Release of entrapped tissue
Repair of bony defect
Anterior segment complications of blunt trauma

Hyphaema Sphincter tear Iridodialysis Vossius ring

Cataract Lens subluxation Angle recession Rupture of globe

Posterior segment complications of blunt trauma

Commotio retinae Choroidal rupture and Avulsion of vitreous base

haemorrhage and retinal dialysis

Equatorial tears Macular hole Optic neuropathy

 Complications of penetrating trauma

Flat anterior chamber Uveal prolapse Damage to lens and iris

Vitreous haemorrhage Tractional retinal detachment Endophthalmitis

 Management of intraocular foreign bodies

Localization with reference to radio- Removal with magnet or by pars plana

opaque marker vitrectomy
 Grading of severity of chemical injuries
Grade I (excellent prognosis)
Clear cornea
Limbal ischaemia - nil

Grade II (good prognosis) Grade III (guarded Grade IV (very poor

prognosis) prognosis)

Cornea hazy but visible No iris details Opaque cornea

iris details
Limbal ischaemia < 1/3 Limbal ischaemia - 1/3 to 1/2 Limbal ischaemia > 1/2
 Medical Treatment of Severe Injuries
1. Copious irrigation ( 15-30 min ) - to restore normal pH

2. Topical steroids ( first 7-10 days ) - to reduce inflammation

3. Topical and systemic ascorbic acid - to enhance collagen production

4. Topical citric acid - to inhibit neutrophil activity

5. Topical and systemic antibiotic- to inhibit collagenase and neutrophil activity

Surgical treatment of severe chemical injuries

Division of conjunctival bands

Correction of eyelid deformities Treatment of corneal opacity by

keratoplasty or keratoprosthesis
 HIFEMA
Yaitu darah didalam Kamera Okuli Anterior

Penyebab :
TRAUMA
1. PRIMER:
Segera setelah trauma
2. SEKUNDER
5-7 hari setelah trauma

SPONTAN
Mis : Rubeosis iridis
 PENANGANAN HIFEMA
1. Rawat / Istirahat total
2. Posisi kepala 60o
3. Anti perdarahan
4. Awasi:
TIO / Perdarahan sekunder
5. Parasentesis
SEBELUM SESUDAH
PEDOMAN PENANGANAN
PERTAMA
1. LASERASI PALPEBRA
Amati adanya akibat lain di mata
Bebat mata
ATS

2. LASERASI KONJUNGTIVA
Kecil Konservatif
Besar / Luas Jahit
3. LASERASI KORNEA
KATEGORI

1. LAMELAR
2. LUKA TEMBUS
- Dapat menutup sendiri
- KOA dalam
- HA tidak keluar secara aktif
3. LUKA TEMBUS
- HA merembes, KOA dangkal
- Tidak melibatkan Uvea / lensa
4. LUKA TEMBUS
- Melibatkan Jaringan Intraokuler
 PENANGANAN
1. KATEGORI 1 & 2
- Konservatif :
- Anti Biotika
- Bebat mata Follow Up

2. KATEGORI 3 & 4
- Jangan manipulasi
- Jangan beri Sikloplegik
(kecuali terpaksa menunda rujukan )
- Bebat mata (kassa steril)
- ATS & Antibiotika parenteral
- Rujuk
4. BENDA ASING di KORNEA
Tetes anestesi topikal
Ekstraksi Corpus Alienum
Lakukan secara hati-hati dengan menggunakan
aplikator kapas Cotton buds atau diirigasi
Bila gagal RUJUK
Follow up setelah 24 jam
RUJUK Bila ada komplikasi
 BENDA ASING PADA MATA

JENIS :
LOGAM
NON LOGAM

REAKSI :
- BENDA INERT
- BENDA REAKTIF
AKIBAT : PENANGANAN :
SUPERFISIAL BENDA ASING DIPERMUKAAN
Ekstraksi sepanjang
TEMBUS :
memungkinkan
PERDARAHAN BENDA ASING INTRA OKULER
REAKSI JARINGAN :
MATA : INERT BIARKAN
SIDEROSIS
REAKTIF DIAMBIL
KALKOSIS
(Rujuk ke RS dengan
Fasilitas)
TRAUMA - FISIS
 TRAUMA - FISIS

THERMIS PANAS - DINGIN

SINAR SINAR - X
ULTRA - VIOLET
INFRA - MERAH
 SINAR X Katarak
INFRA MERAH Retinipathi Solaris, Katarak

ULTRA VIOLET Keratitis Superfisial

Las - Listrik
Sirkit Pendek

Back
TRAUMA
PSIKIS
 TRAUMA PSIKIS
STRES

CSR (Central Serous ChorioRetinopati)

 OFTALMIA SIMPATIKA
UVEITIS BILATERAL GRANULOMATOSA DIFUSA
EXITING EYE
SIMPATIZING EYE

TRAUMA TEMBUS YANG MENGENAI UVEA

TERJADI : 10 HARI BERTAHUN-TAHUN
ETIOLOGI : REAKSI HIPERSENTIVITAS PIGMEN
UVEA
TERAPI : ENUKLEASIO BULBI
( EXITING EYE )
UVEITIS
( SIMPATIZING EYE )
OFTALMIA SIMPATIKA

UVEITIS pada salah satu mata,

yang disebabkan oleh karena
trauma tembus yang mengenai
uvea mata kontra lateral.
ORBITAL TUMOR
ORBITAL TUMOURS
1. Vascular tumours
Capillary haemangioma
Cavernous haemangioma
2. Lacrimal gland tumours
Pleomorphic adenoma
Carcinoma
3. Neural tumours
Optic nerve glioma
Optic nerve sheath meningioma
Sphenoidal ridge meningioma

4. Miscellaneous tumours
Lymphoma
Rhabdomyosarcoma
Metastases
Invasion from sinuses
Capillary haemangioma
Most common orbital tumour in children
Presents - 30% at birth and 100% at 6 months

Most commonly in superior anterior orbit

May enlarge on coughing or straining
Associated strawberry naevus is common
 Capillary haemangioma
Natural history Systemic associations

High output cardiac failure

Kasabach-Merritt syndrome -
thrombocytopenia, anaemia
Maffuci syndrome - skin
haemangiomas, enchondromata

Treatment

Steroid injections - for superficial

component

Systemic steroids

Growth during first year Local resection - difficult

Subsequent resolution -
complete in 70% by age 7 years
 Cavernous haemangioma
Most common benign orbital tumour in adults
Usually located just behind globe
Female preponderance - 70%
Presents - 4th to 5th decade

Slowly progressive axial proptosis May cause choroidal folds

Treatment - surgical excision

Classification of lacrimal gland tumours

()
 Pleomorphic Lacrimal Gland Adenoma
Presents - 4th to 5th decade

Painless and very slow- Posterior extension may Smooth, encapsulated

growing, smooth mass in cause proptosis and outline
lacrimal fossa ophthalmoplegia Excavation of lacrimal gland
Inferonasal globe fossa without destruction
displacement
 Technique of surgical excision
Biopsy is contraindicated
Prognosis - good if completely excised

Incision of Drilling of bone

temporal muscle for subsequent
and periosteum wiring

Removal of
lateral orbital Repair of
wall and temporal muscle
dissection of and periosteum
tumour
 Lacrimal gland carcinoma
Presents - 4th to 6th decades
Very poor prognosis

Painful, fast-growing mass in Posterior extension may cause proptosis,

lacrimal fossa ophthalmoplegia and episcleral congestion
Infero-nasal globe displacement Trigeminal hypoaesthesia in 25%

Management
Biopsy
Radical surgery and radiotherapy
 Optic nerve glioma
Typically affects young girls
Associated neurofibromatosis -1 is common
Presents - end of first decade with gradual visual loss

Gradually progressive proptosis Optic atrophy

Treatment
Observation - no growth, good vision and good cosmesis
Excision - poor vision and poor cosmesis
Radiotherapy - intracranial extension
Optic nerve sheath meningioma
Typically affects middle-aged women

Gradual visual loss due to optic nerve Optociliary shunts in

compression 30%

Proptosis due to intraconal spread Thickening and

calcification on CT
Treatment
Observation - slow-growing tumours
Excision - aggressive tumours and poor vision
Radiotherapy - slow-growing tumours and good vision
 Sphenoidal ridge meningioma
Presents with gradual visual loss and reactive hyperostosis

Proptosis Fullness in temporal fossa Hyperostosis on plain x-ray

 Lymphoma
Presents - 6th to 8th decades

Affects any part of orbit and Anterior lesions are rubbery May be confined to
may be bilateral on palpitation lacrimal glands

Treatment
Radiotherapy - localized lesions
Chemotherapy - disseminated disease
 Rhabdomyosarcoma
Most common primary childhood orbital malignancy
Rapid onset in first decade ( average 7 yrs )

May involve any part of orbit Palpable mass and ptosis in about 30%

Treatment
Radiotherapy and chemotherapy
Exenteration for radio-resistant or recurrent tumours
 Childhood metastatic tumours
Neuroblastoma Chloroma

Presents in early childhood Presents at about age 7yrs

May be bilateral Rapid onset proptosis - may be bilateral
Typically involves superior orbit Subsequent systematic dissemination to
full-blown leukaemia
 Adult metastatic tumours
Common primary sites - breast, bronchus, prostate, skin melanoma,
gastrointestinal tract and kidney
Presentations

Anterior orbital mass with non- Enophthalmos with schirrous

axial globe displacement tumours

Similar to orbital pseudo-tumour Cranial nerve involvement at orbital

apex and mild proptosis
 Orbital invasion by sinus tumours

Maxillary carcinoma Ethmoidal carcinoma

Upward globe displacement and epiphora Lateral globe displacement

terimakasih