OCULAR TRAUMA

DR. CAO NGOC THACH

OCULAR TRAUMA
 EPIDEMIOLOGY

• Ocular trauma is a common emergency in ophthalmology

• USA:
• > 2,5 million eye injuries occur annually
• > 400.000 people are unilaterally blind

• The fifth leading cause of blindness in Vietnam(2002)

• Men/women = 4.6/1 (USEIR); 4.3/1 (HEIR)
• Mean Age: 33 (USEIR); 29 (HEIR)
 CLASSIFICATION - BETT
• Closed globe injury : No full-thickness wound of eyewall
• Lamellar laceration : Partial-thickness wound of the eyewall
• Contusion : No (full-thickness) wound

• Open globe injury : Full-thickness wound of the eyewall

• Rupture : Full-thickness wound of the eyewall /blunt object
• Laceration : Full-thickness wound of the eyewall /sharp object
• Perforating injury : Entrance and exit wounds
• Penetrating injury : Entrance wound
• Intraocular foreign body : Retained foreign object(s)
CLASSIFICATION - BETT
 LAMELLAR LACERATION
Lamellar corneal laceration:
• Symptoms: pain, photophobia, discharge.
• Signs: corneal laceration, Test Seidel (-)
• Treatment:
• Broad-spectrum topical antibiotics.
• Corneal glue
• Suturing of lamellar wounds
 LAMELLAR LACERATION

Lamellar scleral laceration :

• Symptoms : pain, photophobia, discharge.

• Signs : scleral laceration

• Treatment : Suturing of lamellar wounds

 CONTUSSION
• Force from a blunt object typically indents the cornea suddenly
and rapidly leading to rapid equatorial expansion
 CLOSED GLOBE INJURIES: ANTERIOR CHAMBER
• Subconjunctival haemorrhage
• Corneal edema
• Iridocyclitis
• Hyphema
• Mydriasis/ miosis pupil
• Iridodialysis
• Angle recession
• Cyclodialysis cleft
• Trabecular meshwork tear
• Lens subluxation and dislocation
 SUBCONJUNCTIVAL HEMORRHAGE
• Traumatic subconjunctival hemorrhage can be related to trauma
as minor as excessive eye rubbing or as extreme as open globe
injuries
• Treatment: resolve in a matter of days but can take several weeks
if extensive
 CORNEAL EDEMA
• Treatment:
 Prophylactic broad-spectrum antibiotics and observation are the
mainstays of treatment for most corneal abrasions.
 Corneal nutrient drops
 IRIDOCYCLITIS
• Photophobia, irritation, discharge, pain, loss of vision.

• Limbal injection, Tyndall (+), IOP ↓

• Treatment:

 Mild: Atropin

 Severe: combine Corticoid drops

 HYPHEMA
• Pathophysiology: disruption of the ciliary body, iris stroma, and the
major arterial circle and its branches by simultaneous equatorial
globe expansion
 HYPHEMA

• Classification

 0: microhyphema, no visible layering with

some red blood cells in the anterior chamber
 I: <1/3 anterior chamber volumn
 II: 1/3 - ½ anterior chamber volumn
 III: > 1/2 anterior chamber volumn
 IV: Total anterior chamber volumn
 HYPHEMA
• Treatment:
 Maintain bed rest with minimal ambulation only when necessary
 Remain upright or keep the head of their bed angled at more
than 30 degrees
 Acetaminophen

 Cycloplegia : Atropin 1%
 Prednisolone acetate
 Acid aminocaproic

• Sugery: After 5 days: anterior chamber (AC) washout

 MYDRIASIS / MIOSIS
• Iris sphincter muscle injury => Mydriasis.
• Iris dilator muscle spasm => Transient miosis.
 IRIDODIALYSIS
• Iris is separated at its root, may appear as a small, crescent-
shaped black area in the anterior chamber periphery, irregular
pupil
• Surgical repair :
• Indication: iridodialysis > 450, monocular diplopia, glare.
• Contra-indication: uveitis, hyphema, OHT, endophthalmitis
 ANGLE RECESSION
• A gap between the sclera and the
ciliary body with widening of the
suprachoroidal space.
• Secondary Glaucoma
• Treatment:
• Glaucoma medica tions.
• Trabeculetomy ± mitomycin C.
 CYCLODIALYSIS
• Portion of the ciliary body is
disinserted from the sclera.
• Hypotony maculopathy
• UBM, AS-OCT
• Treatment:
 Cycloplegics, corticosteroid
 Argon laser, direct cyclopexy,
cryotherapy, surgery
CATARACT
 LEN SUBLUXATION AND DISLOCATION
• Dislocation of the lens through a site of scleral rupture, under conjunctiva
• Prolapse forward into the anterior chamber
• Falls into the vitreous cavity
CLOSED GLOBE INJURIES: POSTERIOR CHAMBER
• Choroidal Trauma
• Choroidal Hemorrhage
• Choroidal ruptute
• Choroidal effusion

• Retinal Trauma
• Commotio retinae
• Retinal tear
• Retinal detachment

• Vitreous Hemorrhage
 CHOROIDAL HEMORRHAGE
• Dark, dome-shaped elevations of
the retina and choroid, causing a
loss of the red reflex.
• Some suprachoroidal hemorrhages
resolve without surgical
intervention.
• Surgery indications:
• Uncontrol pain
• ↑IOP not respond to glaucoma
medications
 CHOROIDAL RUPTURE
• Break in the retinal pigment epithelium (RPE), Bruch’s membrane,
and the underlying choroid
• Choroid neovascularization.
 CHOROIDAL EFFUSION
• Fluid accumulates within the potential space between the
choroid and the sclera. This potential space extends from the
scleral spur anteriorly to the optic nerve posteriorly.
 COMMOTIO RETINAE

• Damaged photoreceptor outer segments and retinal pigment

epithelium.
• Confluent geographic areas of whitened retina most commonly
appear in the mid-periphery and less commonly in the macula.
 RETINAL TEAR
• Soon: direct impact
• Late: proliferative vitreoretinopathy
• Signs: floater, flash of light
• Treatment: Cryopexy, Argon laser
 RETINAL DETACHMENT
• Signs: loss of vision, floater, flash of light, visual field defect.
• Treatment: Cryopexy, Argon laser, vitrectomy+gas.
 VITREOUS HEMORRHAGE
• Proliferative vitreoretinopathy
=> retinal detachments.
• Complications: ↑IOP, chronic iron
toxicity.
• Surgery: Vitrectomy.
OPEN GLOBE INJURIES
OPEN GLOBE INJURIES
 SIGNS AND SYMPTOMS
• Symptoms: irritation, photophobia, pain, discharge, ciliary spasm,
loss of vision
• Signs:
• Scleral-corneal laceration.
• Anterior chamber: hyphema, hypopyon, foreign.
• Lens: subluxation, dislocation.
• Vireous: Haemohhrage
• Choroidal- Retinal: Tear, detachment.
• Prolapse: iris, vitreous, choroidal-retinal
 TREATMENT
• Principles of treatment:
 Restore the integrity of the eyeball
 Avoid complications
 Improve vision

• Medical treatment:
 SAT
 Antibiotic: combine, broad-spectrum, topical or systemic.
Endopthalmitis => Intraocular Antibiotic.
 Corticoids: Maxitrol, Tobradex or Prednisolone 0,5-1mg/kg/day.
• Surgery: Suturing of wounds, envisceration, enucleation
 COMPLICATIONS

• Endopthalmitis

• Cataract, len subluxation, dislocation

• Chronic Uveitis

• Proliferative vitreoretinopathy

• Retinal detachments
 COMPLICATIONS
• Sympathetic ophthalmia
• Anterior chamber epithelial cyst

• Posterior synechia

• OHT

• Chronic corneal edema

• Corneal Scar

• Amblyopia, strabismus
 PROGNOSIS

• Anterior segment (cornea, len) better prognosis /posterior

segment (vitreous, retinal).

• Poor diagnosis: LP (-), rupture > 10mm, endopthalmitis, retinal

detachment, vitreous haemorrhage, intraocular foreign body.
 INTRAOCULAR FOREIGN BODY
• Size, site, and mechanism of entry as well as the velocity and
composition of the foreign body:
• Anterior Segment: cornea, anterior chamber, len.
• Posterior Segment: vitreous, choroid-retina.

• Pathophysiology:
• Intraocular foreign body: endopthalmitis, chronic retinal toxicity.
• Complications: uveitis, Proliferative vitreoretinopathy, retinal
detachment, …
 CLASSIFICATION
• Metal:
• Magnetic: steel
• Non Magnetic: copper, aluminum, …

• Non-metal: organic, stone, glass plastic, …

METAL NON-METAL
TOXIC NON-TOXIC TOXIC NON-TOXIC
Lead Gold Organic Stone
Zinc Argentum Fur Glass
Aluminum Platin Porcelain
Copper Carbon
Steel Plastic
 CLINAL FEATURES
• Symptoms: pain, loss of vision.
• Signs: entrance (cornea, sclera, conjunctiva).
 MEDICAL IMAGE

• XQ

• CT, MRI

• Ultrasound
MEDICAL IMAGE
THANK YOU
FOR YOUR
ATTENTION!