3. Trauma Rekonstruksi Mata
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TRAUMA REKONSTRUKSI DAN
OKULOPLATIK
TRAUMA REKONSTRUKSI DAN
OKULOPLATIK
dr. Sri Inakawati. SpM(K)
DIVISI TRAUMA, REKONSTRUKSI dan OKULOPLASTIKDEPARTEMEN ILMU KESEHATAN MATA
FAKULTAS KEDOKTERAN UNIV. DIPONEGORO/ RSUP Dr. KARIADISEMARANG
EPIDEMIOLOGY
- Early adulthood >>- Vision threatening - Male : female 3-5 : 1- Visual loss > lower socioeconomic stara
and underdevelop countries - Preventable esspecially in the workplace- Recurrent disease 3X seecond injury
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EPIDEMIOLOGY...
- Prevalence : +/- 20%- >> hospitalized - Study in Sing (emergency departemen) :
71% work related 21,7% with eye protection43,7% did not use34,6% not provided
TRAUMA MATATRAUMA MATA
PEMBAGIAN TRAUMA :- TRAUMA MEKANIS- TRAUMA KIMIA- TRAUMA FISIS- TRAUMA PSIKIS
PEMERIKSAAN
VISUALISASI
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PEMERIKSAANPEMERIKSAAN
PEMERIKSAANPEMERIKSAANANAMNESA :
– Proses terjadinya Trauma - Kapan/Jenis – Penanganan – pertama– Prakiraan – Visus– Hubungan – Trauma & Visus
STATUS OFTALMOLOGI :VisusSegmen – Depan & belakangKeadaan bola mata :
Bentuk / Gerak / Kedudukan, dll
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Pemeriksaan yang diperlukan :• LOUPE• OBLIG ILLUMINASI / SLIT LAMP• OFTALMOSKOP• RONTGEN• USG• CT SCAN
PEMERIKSAANPEMERIKSAAN
PERALATAN DASAR
1. OPTOTIPE2. PINHOLE3. LAMPU SENTER4. LOUPE5. OFTALMOSKOP6. KAPAS LIDI 7. ANESTHESI TOPIKAL
8. AIR BERSIH9. EYE SPECULUM10.FLOURESEIN11.BEBAT MATA12.EYE SHIELD13.PLESTER
Back
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TRAUMAMEKANISTRAUMAMEKANIS
TRAUMA MEKANIS
TRAUMA TAJAM : TRAUMA TUMPUL :
Closed Globe
Open Globe
Melibatkan
Dinding orbita
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TRAUMA – TAJAMClosed Globe
Laserasi- Palpebra Ruptur kanalis lakrimalis- Konjungtiva
Luka lamelar- Kornea- Sklera
Putusnya otot-otot ekstra okuler
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Type of defect - Palp. Laceration :
• Size : Small, Moderate, Large• Depth : Partial / Full Thickness• Location : Canthal involvement / lacrimal
system involvement
TRAUMA – TAJAMOpen Globe
Ruptur
Kornea / Sklera
Sering disertai :
- Penurunan VISUS
- Khemosis, Ekhimosis
- Prolaps Isi Bola Mata : Iris , Lensa, Korpus Vitreum, Khoroid
COA :
Dangkal, HifemaLensa : Katarak (katarak traumatika), Ruptur Lensa
PROLAPS CV
Retina : Ablasio retina
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TRAUMA TUMPUL
1. Palpebra Hematom 2. Konjungtiva Khemosis 3. Kornea Erosi4. COA Hifema 5. Iris Iridoreksis, Iridodialisis6. Lensa Luksasi, Sub Luksasi7. Korpus Vitreum perdarahan (Hemoftalmus)8. Retina Ablasio9. Bola Mata Eksoftalmus, Enoftalmus
Kerusakan dinding orbita Blow out fraktur
NON PERFORASI
PERFORASI
Prolap isi bola mata Sembuh Ptisis-bulbi.
Orbital floor fractures :
1. Direct fractures (Unpure “Blowout fractur”)
2. Indirect fractures (Pure “Blowout fractur”)
BLOW OUT FRACTURE
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Pure blowout fracture
Unpure blowout fracture
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Blunt force ( > than the orbital Rim)
Inferior orbital rim compresses
Buckling of the orbital floor
Mechanism blowout fracture
Dasar Diagnosis
• Sign - Ekhimosis, edema palpebra- Diplopia- Exoftalmus (edema >>, orbital
hemorrhage) Enoftalmus- Ptosis- Hypestesia
• CT Scan
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HIFEMA Yaitu darah didalam Kamera Okuli Anterior
Penyebab :
TRAUMA1. PRIMER:
Segera setelah trauma2. SEKUNDER
5-7 hari setelah trauma
SPONTAN Mis : Rubeosis iridis
PENANGANAN HIFEMA1. Rawat / Istirahat total
2. Posisi kepala 60o
3. Anti perdarahan
4. Awasi:
TIO / Perdarahan sekunder
5. Parasentesis
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PEDOMAN PENANGANANPERTAMA
1. LASERASI PALPEBRA Amati adanya akibat lain di mata Bebat mata ATS
Prinsip terapi : kembalikan fungsi perlindunganthd bola mata, fungsi ekskresi kan
lakrimalis dan kosmetik jahit + rekanalisasi
2. LASERASI KONJUNGTIVA Kecil Konservatif (Topikal AB) Besar / Luas Jahit
3. LASERASI KORNEAKATEGORI
1. LAMELAR2. 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
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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
Prinsip terapi : jahit kornea / sclera (bila memungkinkan)
PENANGANAN
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
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BENDA ASING PADA MATA
JENIS : LOGAM
NON LOGAM
REAKSI :
- BENDA INERT
- BENDA REAKTIF
AKIBAT :• SUPERFISIAL
• TEMBUS :– PERDARAHAN
– REAKSI JARINGAN MATA
PENANGANAN :• BENDA ASING DIPERMUKAAN Ekstraksi sepanjang memungkinkan
• BENDA ASING INTRA OKULER :
– INERT BIARKAN
– REAKTIF DIAMBIL(Rujuk ke RS dengan Fasilitas)
bACK
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TRAUMAKIMIA
TRAUMAKIMIA
TRAUMA KIMIAKasus kegawatan oftalmik
Dibagi 2 : Trauma Asam Trauma Basa
Trauma Basa > merusak dibanding Trauma AsamBasa bereaksi dengan lemak penyabunan
merusak sel membran Berat ringan
tergantung • Vol• Konsentrasi• Kecepatan difusi
• CaOH – ringan• KOH• NaOH • Ammonium Hydroxide
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COMMON ACIDS AND ALKALIPRODUCKCHEMICAL Ph
Alkalies
Dishwasher detergent Sodium tripolyphosphate12,0Oven cleaners Sodium hydroxide1,4
Ammonia Ammonium hidroxide12,5
Drain cleaner Sodium or potasium hydroxide 14
AcidsToilet cleaner Sulfuric acid ( 80 % )
1,0
Pool cleaners Sodium or calcium hypochloride 1,0
Battery fluid Sulfuric acid ( 30 % )1,0
Bleaches Sodium hypochloride 1,0
TRAUMA-ALKALI THOFT
Derajat 1 : Hiperemi KonjungtivaKeratitis Pungtata
Derajat 2 : Hiperemi KonjungtivaHilangnya Epitel Kornea
Derajat 3 : Hiperemi/Nekrosis KonjungtivaHilangnya Epitel Kornea
Derajat 4 : Konjungtiva – PerilimbalNekrosis 50 %
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CLASSIFICATION OF ALKALI BURNS
Grade 1Corneal epithelial damageNo conjunctival ischemia
Good prognosis
Grade 3Total epithelial loss with stromal haze, iris detail seen nne – third to one-half of limbus ischemic
vision reduced, perforation rare
Grade 2Hazy cornea, iris detail seen
Less than one – third of limbusischemic
Good prognosis
Grade 4Cornea opaque, no details or iris seenMore than one-half of limbus ischemic
Poor prognosis, chronic course
PENGOBATANTRAUMA - ALKALI
1. Netralisasi – Irigasi dengan air 30 menit
2. Ukur PH Air-mata3. Debridement, Antibiotika4. Diberikan – Sikloplegik5. Hati-hati dengan Steroid6. Lensa Kontak
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TRAUMA ASAM Penetrasi Zat Asam kejaringan
berlangsung lambat, karena terjadi koagulasi protein
sama dengan penanganan Trauma Alkali
PENANGANAN PENANGANAN
BACK
TRAUMA - FISISTRAUMA - FISIS
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TRAUMA - FISISTRAUMA - FISIS
PANAS - DINGIN
SINAR
THERMIS
INFRA - MERAHULTRA - VIOLET
SINAR - X
SINAR X Katarak
INFRA MERAH Retinopathi Solaris, Katarak
ULTRA VIOLET Keratitis Superfisial
Las - Listrik Sirkit Pendek
Back
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TRAUMA PSIKIS
TRAUMA PSIKIS
TRAUMA PSIKIS
STRESSTRES
CSR (Central Serous ChorioRetinopati)
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OFTALMIA SIMPATIKA
UVEITIS BILATERAL GRANULOMATOSA DIFUSA
EXITING EYESIMPATIZING EYE
OK TRAUMA TEMBUS YANG MENGENAI UVEATERJADI : 10 HARI – BERTAHUN-TAHUNETIOLOGI : REAKSI HIPERSENTIVITAS PIGMEN
UVEATERAPI : ENUKLEASIO BULBI
( EXITING EYE )UVEITIS
( SIMPATIZING EYE )
OFTALMIA SIMPATIKAUVEITIS pada salah satu mata, yang disebabkan oleh karena trauma tembus yang mengenai uvea mata kontra lateral.
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HAL PENTING YANG PERLU DIPERHATIKAN
1. ANAMNESA yang mengarah2. Periksa VISUS sebelum terapi / sebelum
dirujuk ( kecuali trauma kimia )3. RUJUK bila visus kurang dari 6 / 184. MANIPULASI MINIMAL
KELAINAN PALPEBRA
1. ENTROPION DAN EKTROPION2. LAGOFTALMUS3. PTOSIS4. TRICHIASIS5. DISCHIASIS
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ENTROPION/EKTROPION
Eyelid margin inversion/Eversion
Contact between eyelid margin/ eyelash and ocular surface/Conjungtival
exposes
Operative
LAGOFTALMUS
PALPEBRA TIDAK BISA MENUTUP DENGAN RAPATPENYEBAB KELEMAHAN OTOT ORBIKULARIS OKULI, PARESE N.VII
PTOSISPALPEBRA TIDAK BISA TERBUKA LEBARBISA KONGENITAL / AKUISITA
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TRICHIASIS
PERTUMBUKAN BULU MATA YANG MENGARAH KEDALAM
DISCHIASISBULU MATA YANG TUMBUH TIDAK PADA TEMPATNYA BIASANYA PADA MUARA KELENJAR MEIBOM. BISA MEMBENTUK 2 BARISAN BULU MATA
bACK
VISUALISASIVISUALISASI
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Retina Normal
Retinopati serosa sentral
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Trauma asam pada korneaTrauma asam pada kornea
Trauma basaTrauma basa
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Erosi KorneaErosi Kornea
Hematoma palpebraHematoma palpebra
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Laserasi palpebraLaserasi palpebra
Laserasi palpebraLaserasi palpebra
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GramGram
Ruptur BulbiRuptur Bulbi
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ChemosisChemosis
Imbibisi KorneaImbibisi Kornea
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HifemaHifema
IridodialisisIridodialisis
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Blow Out FractureBlow Out Fracture
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