AND

MANAGEMENT

INTRODUCTION
INDUSTRY

TRAUMA

>>
PRODUCTIVE AGE

BLIND

EYEBALL DEFENCE MECHANISM

RIMA/ORBITAL BONES
EYE CLOSING REFLEX
EVASIVE AND
DODGING HEAD
MANEUVER TO AVOID
DANGER TO THE EYE

EYE
TRAUMA
CLOSED
EYEBALL
CONTUSI
O

OPEN EYEBALL

LAMELLAR
LACERATION

PENETRATION

LACERATION

RUPTURE

IOFB

RUPTUR
E

CICENDO EYE Hosp. STUDY

(1991-1992)

2,1 % TRAUMA CASES

MALE : FEMALE = 94 : 6
CHILD > ADULT
EDUCATION :

ELEMENTARY SCHOOL : 38,8 %

JUNIOR HIGH SCHOOL : 27,9 %
SENIOR HIGH SCHOOL : 25,7 %

OCCUPATION :

HARD LABOUR : 85,8 %

STUDENT : 6,5 %
GOVT. EMPLOYEE : 3,8 %
JOBLESS : 2,2 %
MILITARY : 0,7 %

LOCATION :

WORKPLACE : 67,3 %
HOME
: 18,4 %
ROAD
: 9,2 %
FARM
: 2,1 %
SPORT AREA : 1,7 %
SCHOOL
: 1,3 %

PENYEBAB TRAUMA

TRAFFIC ACCIDENT, FIGHT, FELL DOWN

WOOD, IRON, FIST
BADMINTON, FOOTBALL, TENNIS, GOLF
PENCIL, MACHETTE/KNIFE

10,7 % OF ALL TRAUMA CASES

BLINDNES
S

EXAMINATION
ANAMNESION
!

COMPLETE TRAUMA HISTORY :

TIME
LOCATION
ACTIVITY
EYE PROTECTION DEVICES
CAUSE

EYE EXAMINATION
VISUAL ACUITY
VISUAL FUNCTION
SNELLEN CHART
DISTANT
PAPERS/MAGAZINE
S NEAR

ONE BY ONE
SWOLLEN LIFT THE
EYELID CAREFULLY
WITHOUT PRESSING
THE EYEBALL

EXTERNAL EXAMINATION
EYELID

TORCH + BINOCULAR
LOUPE
LACERATION DEPTH,
AREA, AVULSION &
LACRIMAL APP.
GLASS/FOREIGN BODY
EVERSION OF THE EYELID
AREA PALPATION #
ORBITA/NASAL
DRAWING FOR EYELID
RECONSTRUCTION

CONJUNCTIVA

SLIT LAMP
BIOMICROSCOPY
SUB CONJUNCTIVAL
BLEEDING/CHEMOS
IS SMALL
POSSIBILITY FOR
PENETRATING
WOUND
LOCAL CHEMOSIS
IOFB/SCLERAL
RUPTURE

CORNEA

SLIT LAMP BIOMICROSCOPY

DETERMINE IOFB/ABRATION/WOUND
(PERFORATION/NOT)
AVULSION SHAPE & AREA OF PROLAPS
LIMBAL POSSIBILITY EXTENT TO YHE
SCLERA SURGERY + EXPLORATION
SCHEMATIC DIAGRAM WOUND &
POSITION SURGERY

EYEBALL MOVEMENT

DETERMINE UP, DOWN, RIGHT &

LEFT

ANTERIOR CHAMBER

HYPHAEMA

SLIT LAMP BIOMICROSCOPY

SEVERE BLOOD CLOT BLACK BALL
SECONDARY FEW DAYS AFTER TRAUMA
7% GLAUCOMA IN THE NEXT YEARS

DEPTH

SHALLOW CHOROIDAL HAEMORRHAGE /

DETACHMENT, PERFORATING WOUND,
ANTERIOR LUXATION OF THE LENS

IRIS

IRIDODIALISA
IRIS SPHINCTER RUPTURE
FOREIGN BODY
PROLAPSED IRIS

PUPIL

CONNECTION INTRACRANIAL DAMAGE

SIZE, SHAPE, LIGHT REFLEX
BLUNT TRAUMA PUPIL DILATED

LENS

LENS OPACITIES (CATARACT),

ANTERIOR/POSTERIOR CAPSULE
RUPTURE
POSITION SUB-LUXATED/
DISLOCATED
PERFORATING TRAUMA ANTERIOR
CAPSULE RUPTURE + INTRA
LENTICULAR FOREIGN BODY

FUNDUS EXAMINATION

POSTERIOR SEGMENT OF
THE EYEBALL
OPHTHALMOSCOP
IMPORTANT :
VITREOUS CLARITY,
IOFB LOCATION
POSTERIOR EYEBALL
PENETRATING WOUND
MACULAR &
CHORIORETINAL
HAEMORRHAGE,
RETINAL DETACHMENT
OPTIC DISC CONDITION

INTRA OCULAR PRESSURE

PALPATION/ SCHIOTZ TONOMETRY

LOW SCLERAL RUPTURE

ADDITIONAL EXAMINATION

X RAY : IOFB, SEVERE TRAUMA # OF

SURROUNDING BONES
USG/SCANNING # FLOOR & ORBITAL BONES,
IOFB DETECTION, POSTERIOR SEGMENT CANNOT
BE EXAMINED BY OPHTHALMOSCOP

MANAGEMENT
EYELID TRAUMA

SAME PRINCIPAL WOUND IN OTHER

PLACES SMALL WOUND, SUPERFICIAL,
PARALLEL WITH SKIN FOLDS NO NEED
FOR STITCHES + TOPICAL ANTIBIOTIC (E/O)

REFER PALPEBRAL LACERATION

CUTTING THE EDGE OF THE

EYELID/PERFORATING THE ORBITAL SEPTUM

DEFORMITY PREVENTION CONTRACTURE

LACRIMAL APP. TRAUMA

REFER WOUND IN MEDIAL OF

THE EYELID MATA AFFECT THE
PUNCTUM/LACRIMAL CANALICULI

INTRA/EXTRA OCULAR FOREIGN BODY

PRINCIPAL EXTIRPATE

REFER WITH TOPICAL AB

CHEMICAL TRAUMA OF THE EYE

& ADNEXA

VERY DANGEROUS, ACID / BASE

BASE :

CELL/TISSUE DAMAGED/LYSIS
PENETRATION TO THE CORNEA & AC
DAMAGE >> SEVERE

ACID :

DAMAGE AFTER FEW HOURS

PENETRATION <<

BASE:

HOUSE CLEANER, CAUSTIC SODA,

CAR POLISHER, WHITENER, CEMENT

ACID:

BATTERY, INDUSTRIAL CLEANER,

FOOD OR FRUIT PRESERVATIVE,
GLASS POLISHER, VINEGAR

MANAGEMENT :

IRIGATE WITH
FLOWING WATER,
(NO NEED TO BE
STERILE) 30
MINUTE

COMMUNITY HEALTH
CENTER
INFUSION SET +
AQUADEST / NaCL
0,9 %

REFER

Grading of severity of chemical injuries

Grade I
(excellent prognosis)
Clear cornea
Limbal ischaemia - nil

Grade II
(good prognosis)

Cornea hazy but visible

iris details
Limbal ischaemia < 1/3

Grade III
(guarded prognosis)

Grade IV
(very poor prognosis)

No iris details

Limbal ischaemia - 1/3 to 1/2 Limbal ischaemia > 1/2

Opaque cornea

THERMAL TRAUMA

EYELID EDEMA-HYPEREMIC
SELDOM AFFECT THE CORNEA
BLINK REFLEX
CAUSE >> SIGARETTE
TH/ IF AFFECT THE CORNEA
TOPICAL AB + CYCLOPLEGIC

REFER

CONJUNCTIVAL TRAUMA
HAEMORRAGE DISSAPEARED IN FEW
WEEKS
EDEMA/CHEMOSIS SCLERAL
RUPTURE
CONJUNCTIVAL LACERATION
EXPLORE POSSIBILITIES OF
SCLERAL PERFORATION
REFER

EXTRA OCULAR MUSCLE TRAUMA

AVULSION/MUSCLE LOSS RARE

CANNOT MOVE TO THE DIRECTION OF

MUSCLE LOSS

REFER

CORNEA TRAUMA

REFER

ANTERIOR CHAMBER TRAUMA

HYPHAEMA TOTAL BEDREST + SEDATIVE

PARACENTHESA 5 DAYS HYPHAEMA
STAYS / IOP CANNOT BE CONTROLLED BY
MEDICATION

REFER

LENS & SCLERAL TRAUMA (RUPTURE)

REFER

Anterior segment complications of blunt traum

Hyphaema

Cataract

Sphincter tear

Lens subluxation

Iridodialysis

Angle recession

Vossius ring

Rupture of globe

POSTERIOR SEGMENT

VITREOUS HAEMORRHAGE,
CHOROIDAL RUPTURE & MACULAR
EDEMA

REFER

Posterior segment complications of blunt traum

Commotio retinae

Equatorial tears

Choroidal rupture and

haemorrhage

Macular hole

Avulsion of vitreous base

and retinal dialysis

Optic neuropathy

Complications of penetrating trauma

Flat anterior chamber

Vitreous haemorrhage

Uveal prolapse

Tractional retinal detachment

Damage to lens and iris

Endophthalmitis

TIME (INTERVENTION) IN EYE

TRAUMA

Absolute Emergencies

Chemical Trauma (base>acid)

Sub Conjunctival Haemorrhage
Intraocular gas bubble
Orbital abcess
Expanding orbital haemorrhage

Urgent (<< 24 hours)

High risk IOFB

Endophtalmitis
Open wound that need stitches

Within few days (24-72 hrs)

Hyphaema with IOP pressure elevation

(uncontrolled)
Lens Trauma with uncontrolled IOP
pressure elevation
Retinal Detachment
Thick submacular hemorrhage

Within 2 weeks

IOFB
Secondary reconstruction (eg:retinal)
Media opacity in the amblyopic age group

RANGE OF VISION LOSS

(WHO 1974)

Normal Vn (N & near N)

Low Vn

20/70-20/160 / 20/200-20/400

Blindness (Near Blindness)

20/12-20/25 / 20/30-20/60

20/1250-20/2500

Total Blindness

NLP

EYE TRAUMA PATIENT

REHABILITATION
Visual Disorders
impairment

Visual

The organ
Anatomical changes
changes

Visual disability
handicap

Visual

The person
Functional

Skill and ability

economic

Social and

consequences

Quality of the eye

Medical and surgical

adapted
intervention

Visual aids,
equipment

Quality of life

Social interventions, training

counseling,
education

PREVENTION

WORKER HAZZARDOUS WORKING

AREA INITIAL EXAMINATION
ABNORMALITY DETECTION
INFORMATION :

WORKER PROTECTIVE EYEGLASSES

PARENTS CHOOSING THE TOYS AND
GUIDANCE

SPORTS AREA EYE PROTECTOR