Ocular Trauma

Muhammad Asroruddin
asroruddin@gmail.com

Department of Ophthalmology
Faculty of Medicine University of Tanjungpura

Modul P2K2
Anatomy
 TRAUMA
1. Eyelid
• Haematoma
• Margin laceration
• Canalicular laceration

2. Orbital blow-out fractures

• Floor
• Medial wall

3. Complications of blunt trauma

• Anterior segment
• Posterior segment

4. Complications of penetrating trauma

5. Management of intraocular foreign bodies

6. Chemical injuries
 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

Choroidal rupture and Avulsion of vitreous base

Commotio retinae and retinal dialysis
haemorrhage

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 tetracycline - to inhibit collagenase and neutrophil activity

Surgical treatment of severe chemical injuries

Division of conjunctival bands

Treatment of corneal opacity by

Correction of eyelid deformities keratoplasty or keratoprosthesis