CASE REPORT

Department of Ophthalmology

Advisor : dr. Mulia Sitepu, Sp. M

Presented by : Elsya Paramitasari Merina Isnaning Gilbert Iskandar Rocky Chua

Name : Mr. E Sex : Male Age : 36 years old Ethnic : Javanese Religion : Moslem Occupation : Driver Address : Kapuk Muara

 Chief Complaint 1 hour before admission, the patients right eye was exposed by car paint. Additional Complaint Patients right eye felt burning, glare when he saw a bright light and difficult to open.

 History of present illness Since 1 hour before admission, patients right eye was exposed by car paint. He said it felt burning and difficult to open. He felt glare when he saw a bright light. His eye was also felt sticky and watery. He has tried to wash his eye but it still not recovered. Post Ocular History -

 General Medical History -

Familial Medical History -

General condition : well Level of consciousness : fully awake Blood pressure : 128/76 mmHg Heart rate : 90x/min Respiratory rate : 26x/min Temperature : 37,5oC

Right Eye Perioccular Appearance General Condition Eyeball Position Eyeball Movement Visual Acuity Ciliia Sup/Inf Margo Palpebra Sup/Inf Tarsal Conjunctiva Normal Well Orthophoric Can move to 8 direction 5/15 Full, symmetric Well positioned Normal Normal Well

Left Eye

Orthophoric Can move to 8 direction 5/5 Full, symmetric Well positioned Normal

Bulbar Conjunctiva

Normal

Normal

Right Eye Cornea - Clearness - Edema - Infiltrate - Ulcer - Crust - Destruction Scaly Appearance -

Left Eye Clear -

Right Eye Anterior Chamber Iris Pupil Mild Depth Clear Darkish Brown Crypt (+) Center Round 4mm Light Reflex +/+ Isochoric Clear Hyperemic (-) Edema (-) Tenderness (-) Nodule (-)

Left Eye Mild Depth Clear Darkish Brown Crypt (+) Center Round 4mm Light Reflex +/+ Isochoric Clear Hyperemic (-) Edema (-) Tenderness (-) Nodule (-)

Lens Palpebra

 36 years old male came with complaint his right eye was exposed by a car paint. He also complaint that his right eye felt burning, difficult to open, and glare whenever he saw a bright light. From the fluorescence test, we found patch of paint ini his left eye.

 Cornea abration et causa burn alkali trauma.

Conjunctivitis Acute hemorrhagic conjunctivitis Keratoconjunctivitis sicca Ulcus cornea

 Ophthalmoscopy with fluorescence test.

 Rinse the right eye with RL until the pH return to normal.

Quo ad vitam : Quo ad functionam : Quo ad sanationam : Quo ad cosmeticam :

bonam bonam dubia et bonam bonam

 Burns Alkali Trauma

Chemical agents

Eye

Damaged eye

20% significant visual and cosmetic disabilities 15% achieve rehabilitation

60% workplace accidents

30% at home

10% assaults

1:3
3 4 Responsible for approx. 7% of work-related eye injuries

16-45 y.o.

Battery acid

Sulfuric acid

Industrial cleaners Vinegar

Acetic acid

Glacial acetic acid Chemistry laboratories Muriatic acid (cleaner) Bleach

Acid

Hydrochloric acid

Sulfurous acid

Refrigerant Fruit & vegetables preservatives Glass polishing and etching

Hydrofluoric acid

Gasoline alkylation Silicone production

Fertilizer Ammonia Refrigerant Cleaning agent Lye Drain cleaner Plaster

Alkali

Mortar Lime Cement Whitewash Potassium hydroxide Magnesium hydroxide Caustic potash Sparklers Incendiary devices

Alkali burns trauma Broken or damaged tissue cells and saponification accompanied by dissociation of membrane fatty acid further penetration Mucopolysaccharide tissue dissapeared and corneal cell clumping occurs Corneal collagen fibre will swell and cornea will die Edema polymorphonuclear cell will enter into the stroma and accompanied by neovascularization

Plasminogen activator released and collagenase (collagen corneal damaged)

Disruption of epithelial healing

Sustained a corneal ulcer or perforation into the deeper layers

Pain (often extreme)

Foreign body sensation

Blurred vision

Chemical trauma of the eye

Excessive tearing

photophobia

Red eye(s)

Are one or both eyes affected ? Vision Vision at time of examination ? Vision prior to trauma ? Symptoms besides decrease vision ? Symptoms Duration of symptoms? Any surgery prior to trauma ?

History Taking

Vision

Complete Eye Examination

External examination Pupil Motility examination Anterior segment (globe)

Ophthalmoscope
Pressure Visual fields

Ophtalmoscopy with fuorescence test Supported Examination

PH examination on eyeball

The main objective in dealing with trauma to the eye

 The prognosis of alkali trauma is usually worse than the acid trauma.