Skip to main content
SpringerLink
Log in

Stumpfes Augentrauma

Teil II: Stumpfes Hinterabschnittstrauma

Blunt ocular trauma

Part II: blunt posterior segment trauma

  • Weiterbildung · Zertifizierte Fortbildung
  • Published:
Der Ophthalmologe Aims and scope Submit manuscript

Zusammenfassung

In dieser Übersichtsarbeit werden typische Verletzungsmuster im Hinterabschnitt nach Bulbuskontusion oder -ruptur sowie diagnostische und therapeutische Hinweise aufgezeigt. Ein Glaskörperprolaps ist mit Amotio retinae (20%), Irido- oder Zyklodialysen (43%) und Kontusionskatarakt (41%) assoziiert. Nach Bulbuskontusion finden sich ein Berlin-Ödem in 35% und eine Amotio retinae in 5–7%. Bei einem zentralen Berlin-Ödem, Aderhautinfarkten (Hutchinson-Siegrist-Neubauer-Syndrom) oder Aderhautrupturen sollten gezielt Makulaforamina oder choridale Neovaskularisationen (CNV) ausgeschlossen werden. Eine zentrale Aderhautruptur ist gehäuft (14–20%) mit einer CNV assoziiert. Bulbusrupturen (ca. 5% aller stumpfen Verletzungen) sind mit einem Hyphäma Grad III und IV assoziiert (58% vs. 5% bei Bulbuskontusion). Augen mit Bulbusruptur haben 51-mal häufiger einen Visus unter 0,1 im Vergleich zu Kontusionsaugen. Nach vorausgegangener Kataraktoperation ist das Risiko für eine traumaassoziierte Bulbusruptur 27fach erhöht (bei Frauen 5fach gegenüber Männern).

Abstract

This review presents typical patterns of posterior segment injuries as well as diagnostic and therapeutic considerations after ocular contusion or rupture of the globe. Vitreal prolapse is associated with retinal detachment (20%), iridodialysis or ciliary body cleft (43%), and contusion cataract (41%). Berlin’s edema (35%) and retinal detachment (5–7%) are frequent after ocular contusion. In cases of central Berlin’s edema, choroidal infarction (Hutchinson-Siegrist-Neubauer syndrome) or choroidal rupture, macular hole or choroidal neovascularization should be ruled out. A central choroidal rupture is often associated with choroidal neovascularization (14–20%). Globe ruptures (5% of blunt injuries) are associated with hyphema grades III and IV (58 vs 5% in ocular contusions). The prognosis of globe ruptures to develop a visual function <20/200 is 51 times more frequent than in eyes with contusion. The risk of trauma-induced globe ruptures is higher in eyes after cataract surgery (27×) (in females 5×).

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1a, b
Abb. 2
Abb. 3
Abb. 4
Abb. 5
Abb. 6a, b
Abb. 7
Abb. 8a, b
Abb. 9
Abb. 10

Abbreviations

CNV:

Choroidale Neovaskularisationsmembran

EOCR:

Erlanger Okuläres Contusions-Register

EOTR:

Erlanger Okuläres Trauma-Register

HEIR:

Hungarian Eye Injury Registry

ILM:

Membrana limitans interna

ISOT:

International Society of Ocular Trauma

PVR:

Proliferative Vitreoretinopathie

RPE:

Retinales Pigmentepithel

SO:

Sympathische Ophthalmie

STP:

Stauungspapille

TON:

Traumatische Optikusneuropathie

USEIR:

United States Eye Injury Registry

Literatur

  1. Aaberg TM (1970) Macular holes. Am J Ophthalmol 69:555–562

    CAS  PubMed  Google Scholar 

  2. Albert DM, Diaz-Rohena R (1989) A historical review of sympathetic ophthalmia and its epidemiology. Surv Ophthalmol 34:1–14

    Google Scholar 

  3. Amari F, Ogino N, Matsumura M et al. (1999) Vitreous surgery for traumatic macular holes. Retina 19:410–413

    Article  CAS  PubMed  Google Scholar 

  4. Ament CS, Zacks D, Lane AM et al. (2002) Traumatic choroidal rupture: visual outcome and treatment of choroidal neovasculature membrane. Invest Ophthalmol Vis Sci 42 [Suppl 1]:4491

    Google Scholar 

  5. American Academy of Pediatrics, Committe on Sports Medicine and Fitness, American Academy of Ophthalmology, Eye Health and Public Information Task Force (2004) Protective eyewear for young athletes. Ophthalmology 111:600–603

    Google Scholar 

  6. Anderson RL, Panje WR, Gross CE (1982) Optic nerve blindness following blunt forehead trauma. Ophthalmology 89:445–455

    Google Scholar 

  7. Assia EI, Blotnick CA, Powers TP et al. (1994) Clinicopathologic study of ocular trauma in eyes with intraocular lenses. Am J Ophthalmol 117:30–36

    Google Scholar 

  8. Aylward GW, Cooling RJ, Leaver PK (1993) Trauma-induced retinal detachment associated with giant retinal tears. Retina 13:136–141

    CAS  PubMed  Google Scholar 

  9. Berg P, Kroll P, Krause K (1989) Pathomechanismus der Contusio bulbi. Fortschr Ophthalmol 86:407–410

    Google Scholar 

  10. Berlin R (1873) Zur sog. Commotio retinae. Klin Monatsbl Augenheilkd 1:42–78

    Google Scholar 

  11. Binder PS, Waring GO 3rd, Arrowsmith PN, Wang C (1988) Histopathology of traumatic corneal rupture after radial keratotomy. Arch Ophthalmol 106:1584–1590

    Google Scholar 

  12. Blight R, Hart JCD (1977) Structural changes in the outer retinal layers following blunt mechanical non-perforating trauma to the globe: an experimental study. Br J Ophthalmol 61:573–587

    Google Scholar 

  13. Buchwald HJ, Otte P, Lang GK (2003) Evulsio nervi optici nach stumpfem Bulbustrauma. Fallbericht und Literaturübersicht. Klin Monatsbl Augenheilkd 220:303–308

    Article  PubMed  Google Scholar 

  14. Chan CC, Roberge FG, Whitcup SM, Nussenblatt RB (1995) 32 cases of sympathetic ophthalmia. A retrospective study at the National Eye Institute, Bethesda, Md., from 1982 to 1992. Arch Ophthalmol 113:597–600

    Google Scholar 

  15. Cherry PMH (1972) Rupture of the globe. Arch Ophthalmol 88:498–507

    CAS  PubMed  Google Scholar 

  16. Cherry PMH (1978) Indirect traumatic rupture of the globe. Arch Ophthalmol 96:252–256

    Google Scholar 

  17. Chow DR, Williams GA, Trese MT et al. (1999) Successful closure of traumatic macular holes. Retina 19:405–409

    Article  CAS  PubMed  Google Scholar 

  18. Converse JM, Smith B (1957) Enophthalmos and diplopia in fractures of the orbital floor. Br J Plast Surg 9:265–274

    CAS  PubMed  Google Scholar 

  19. Converse JM (1962) Blowout fracture of the orbit. Plast Reconstr Surg 29:408

    Google Scholar 

  20. Converse JM, Smith B, Obear M, Wood-Smith D (1967) Orbital blowout fractures: a ten-year survey. Plast Reconstr Surg 39:20–36

    CAS  PubMed  Google Scholar 

  21. Delori F, Pomerantzeff O, Cox MS (1969) Deformition of the globe under high-speed impact: Its relation to contusion injuries. Invest Ophthalmol 8:290–301

    CAS  PubMed  Google Scholar 

  22. von Domarus D, Deuble-Bente K, Naumann GOH (1997) Trauma, Operationen und Wundheilung des Auges. In: Naumann GOH (Hrsg) Pathologie des Auges, 2. Aufl. Springer, Berlin Heidelberg New York, S 301–377

  23. Drews RC (1994) Delayed onset of sympathetic ophthalmia. Ophthalmic Surg 25:62–63

    Google Scholar 

  24. Duke-Elder S (1961) System of ophthalmology, Bd. 2. Mosby Co, St. Louis, CV, S 83–87

  25. Duke-Elder S, MacFaul PA (1972) Injuries. Mechanical injuries. In: Duke-Elder S (eds) System of ophthalmology, Bd. 14/I. Henry Kimpton, London, pp 150–160

  26. Eagling EM (1974) Ocular damage after blunt trauma to the eye: its relationship to the nature of the injury. Br J Ophthalmol 58:126–140

    CAS  PubMed  Google Scholar 

  27. Eong KA, Kent D, Pieramici DJ (2002) Vitreous and retina. In: Kuhn F, Pieramici DJ (eds) Ocular trauma. Principles and practice. Thieme, New York, S 206–234

  28. Fuchs E (1905) Über sympathisierende Entzündung nebst Bemerkung über seröse traumatische Iritis. Albrecht Graefes Arch Klin Exp Ophthalmol 61:365–458

    Google Scholar 

  29. Garcia-Amuri J, Corcostegui B, Cavero L, Sararols L (1997) The role of vitreoretinal surgery in the treatment of posttraumatic macular hole. Retina 17:372–377

    PubMed  Google Scholar 

  30. Gärtner J (1974) Über die Rolle des Traumas bei der Entstehung der Netzhautabhebung. Ophthalmologica 168:1–12

    Google Scholar 

  31. Girkin CA, Kline LB (2002) Optic nerve and visual pathway. In: Kuhn F, Pieramici DJ (eds) Ocular trauma. Principles and practice. Thieme, New York, pp 392–404

  32. Godtfredsen E (1942) Re-examination of central ruptures of the choroid. Acta Ophthalmol (Copenh) 20:337–350

    Google Scholar 

  33. Goldzieher W (1901) Beitrag zur Pathologie der orbitalen Schußverletzung. Z Augenheilkd 6:277–281

    Google Scholar 

  34. Graefe von (1854) Zwei Fälle von Ruptur der Choroidea. Arch Ophthalmol 1:402–403

    Google Scholar 

  35. Hayreh SS (1975) Segmental nature of the choroidal vasculature. Br J Ophthalmol 59:631–648

    CAS  PubMed  Google Scholar 

  36. Hart JC, Natsikos VE, Raistrick ER, Doran RM (1980) Indirect choroidal tears at the posterior pole: a fluorescein angiographic and perimetric study. Br J Ophthalmol 64:59–67

    Google Scholar 

  37. Hebestreit H, Huppertz HI, Sold JE, Dammrich J (1997) Steroid-pulse therapy may suppress inflammation in severe sympathetic ophthalmia. J Pediatr Ophthalmol Strabismus 34:124–126

    CAS  PubMed  Google Scholar 

  38. Hesse L, Bodanowitz S, Kroll P (1996) Netzhautnekrose nach stumpfem Bulbustrauma. Klin Monatsbl Augenheilkd 209:150–152

    CAS  PubMed  Google Scholar 

  39. Hirata A, Tanihara H (2004) Ruptured internal limiting membrane associated with blunt trauma revealed by indocyanine green staining. Graefes Arch Clin Exp Ophthalmol 242:527–530

    Google Scholar 

  40. vom Hofe K (1957) Netzhautablösung als Spätfolge von Kontusionsverletzungen. Klin Monatsbl Augenheilkd 130:397–400

    PubMed  Google Scholar 

  41. Hollwich F, Jünemann G, Damaske E (1970) Klinischer Beitrag zur Blowout-Fraktur. Klin Monatsbl Augenheilkd 156:864–873

    CAS  PubMed  Google Scholar 

  42. Hutchinson J (1889) Diseases of the choroid. 1. A form of retino-choroiditis due to concussion of the eye. Trans Ophthalmol Soc UK 9:116–126

    Google Scholar 

  43. Inhoffen W (2004) Aderhautfalten, Aderhautruptur und Angioid Streaks. In: Heimann H, Kellner U, Foerster MH (Hrsg) Angiographieatlas des Augenhintergrundes. Thieme, Stuttgart, S 118–119

  44. Kass MA, Lahav M, Albert DM (1976) Traumatic rupture of healed cataract wounds. Am J Ophthalmol 81:722–724

    Google Scholar 

  45. Kroll P, Stoll W, Kirchhoff E (1983) Kontusions-Sog-Trauma nach Ballverletzungen. Klin Monatsbl Augenheilkd 182:555–559

    CAS  PubMed  Google Scholar 

  46. Küchle M, Viestenz A (2003) Association of vitreal prolapse and retinal detachment following „blunt ocular trauma“. 6th Meeting of the International Society of Ocular Trauma. Sopron. Abstract Book, S 163

  47. Kuhn F, Morris R, Witherspoon CD et al. (1996) A standardized classification of ocular trauma. Graefes Arch Clin Exp Ophthalmol 234:399–403

    Article  CAS  PubMed  Google Scholar 

  48. Kuhn F, Mester V, Berta A, Morris R (1998) Epidemiologie schwerer Augenverletzungen. United States Eye Injury Registry (USEIR) und Hungarian Eye Injury Registry (HEIR). Ophthalmologe 95:332–343

    Article  CAS  PubMed  Google Scholar 

  49. Kuhn F, Morris R, Mester V, Witherspoon D (1998) Management of intraoperative expulsive choroidal hemorrhage during anterior segment surgery. In: Stripe M (ed) Anterior and posterior segment surgery: mutual problems and common interests. Ophthalmic Communications Society, New York, pp 191–203

  50. Kuhn F, Morris R, Mester V, Witherspoon C (2001) Internal limiting membrane removal for traumatic macular holes. Ophthalmic Surg Lasers 32:308–315

    Google Scholar 

  51. Kylstra JA, Lamkin JC, Runyan DK (1993) Clinical predictors of scleral rupture after blunt ocular trauma. Am J Ophthalmol 115:530–535

    Google Scholar 

  52. Lang GK, Lang GE, Ruprecht KW (1984) Postkontusionelle ischämische Aderhautinfarkte (Hutchinson-Siegrist-Neubauer). Fortschr Ophthalmol 81:75–79

    Google Scholar 

  53. Lang GK, Bialasiewicz AA, Röhr WD (1991) Beidseitige traumatische Avulsio bulbi. Klin Monatsbl Augenheilkd 198:112–116

    CAS  PubMed  Google Scholar 

  54. Lang W (1987) Injuries and diseases of the orbit. Traumatic enophthalmos with retention of perfect acuity of vision. Adv Ophthalmic Plast Reconstr Surg 6:3–6

    Google Scholar 

  55. Lerman S (1970) Blowout fracture of the orbit. Diagnosis and treatment. Br J Ophthalmol 54:90–98

    CAS  PubMed  Google Scholar 

  56. Lubin JR, Albert DM, Weinstein M (1980) Sixty-five years of sympathetic ophthalmia. A clinicopathologic review of 115 cases (1913–1978). Ophthalmology 87:109–121

    Google Scholar 

  57. Machemer R, Norton EWD (1968) Experimental retinal detachment in the owl monkey. I. Methods of production and clinical picture. Am J Ophthalmol 66:388–396

    Google Scholar 

  58. Martin DF, Awh CC, McCuen BW 2nd et al. (1994) Treatment and pathogenesis of traumatic choroidal rupture (sclopetaria). Am J Ophthalmol 117:190–200

    Google Scholar 

  59. Milauskas AT, Fueger GF (1966) Serious ocular complications associated with blowout fractures of the orbit. Am J Ophthalmol 62:670–672

    Google Scholar 

  60. Mittra RA (2002) Sympathetic ophthalmia. In: Kuhn F, Pieramici DJ (eds) Ocular trauma. Principles and practice. Thieme, New York, pp 301–306

  61. National Society to Prevent Blindness (1980) Vision problems in the U.S.: data analysis. New York, pp 25–26

  62. Neubauer H (1957) Chorioretinopathia traumatica mit sektorenförmigem Gesichtsfeldausfall. Klin Monatsbl Augenheilkd 131:487–500

    CAS  PubMed  Google Scholar 

  63. Pashby TJ (1977) Eye injuries in Canadian hockey. Phase II. Can Med Assoc J 117:671–672, 677–678

    CAS  PubMed  Google Scholar 

  64. Paul L (1905) Ein Fall von Losreissung der Retina von dem Sehnerven nach Bulbusverletzung. Klin Monatsbl Augenheilkd 43:185–191

    Google Scholar 

  65. Pfeiffer RL (1943) Traumatic enophthalmos. Arch Ophthalmol 30:718–726

    Google Scholar 

  66. Power WJ, Foster CS (1995) Update on sympathetic ophthalmia. Int Ophthalmol Clin 35:127–137

    CAS  PubMed  Google Scholar 

  67. Raman SV, Anderson S, Desai UR, Nussbaum JJ (2000) Incidence of ocular injuries in patients with motor vehicle accidents and concomitant air bag development. In: Treister G (ed) 5th International Symposium on Ocular Trauma. Final program and book of abstract; 2000 Juli 6–9. Montreal, Quebec, Kanada, p 32

  68. Rohrbach JM, Weidle EG, Steuhl KP et al. (1996) Traumatic wound dehiscence after penetrating keratoplasty. Acta Ophthalmol Scand 74:501–505

    Google Scholar 

  69. Sachsenweger R (1969) Das indirekte Trauma als Ursache von Netzhautablösungen. Klin Monatsbl Augenheilkd 154:575–582

    CAS  PubMed  Google Scholar 

  70. Schepens CL, Marden D (1966) Data on the natural history of retinal detachment: further characterization of certain unilateral nontraumatic cases, Am J Ophthalmol 61:213–226

    Google Scholar 

  71. Schrader W, Gramer E, Goldmann F, Marcus U (2000) Penetrierende und perforierende Augenverletzungen bei PKW-Unfällen von 343 Patienten vor und nach Einführung des Bußgeldes für „Gurtmuffel“ (1966–1998). Klin Monatsbl Augenheilkd 217:23–29

    Article  CAS  PubMed  Google Scholar 

  72. Seitz R (1963) Ätiologie und Genese der akuten Erblindung als Folge stumpfer Schädelverletzungen. Klin Monatsbl Augenheilkd 143:414–429

    CAS  PubMed  Google Scholar 

  73. Siegrist A (1895) Traumatische Ruptur von Ciliararterien. Am Suisses Sc Med 3:554–571

    Google Scholar 

  74. Sipperley JO, Quigley HA, Gass DM (1978) Traumatic retinopathy in primates. The exploration of commotio retinae. Arch Ophthalmol 96:2267–2273

    Google Scholar 

  75. Smith B, Regan WF (1957) Blowout fracture of the orbit: mechanism and correction of internal orbital fracture. Am J Ophthalmol 44:733–739

    CAS  PubMed  Google Scholar 

  76. Steinsapir KD (1999) Traumatic optic neuropathy. Curr Opin Ophthalmol 10:340–342

    Google Scholar 

  77. Viestenz A, Küchle M (2001) Eine retrospektive Analyse von 417 Kontusionen und Bulbusrupturen und häufig vermeidbarer Unfallursachen: Das Erlanger Okuläre Contusions-Register (EOCR) 1985 bis 1995. Klin Monatsbl Augenheilkd 218:662–669

    Article  CAS  PubMed  Google Scholar 

  78. Viestenz A, Küchle M (2002) Ocular contusion caused by elastic cords: a retrospective analysis using the Erlangen Ocular Contusion Registry. Clin Exp Ophthalmol 30:266–269

    Article  Google Scholar 

  79. Viestenz A, Küchle M (2002) Das Erlanger Okuläre Trauma-Register. Ophthalmologe 99 [Suppl 1]:118

  80. Viestenz A, Küchle M (2002) Choroidal ischemic infarction following ocular contusion with small framed spectacles: Hutchinson-Siegrist-Neubauer-syndrome. Br J Ophthalmol 86:1319

    Google Scholar 

  81. Viestenz A, Küchle M (2003) Bulbusrupturen nach stumpfem Trauma. Klin Monatsbl Augenheilkd 220:13–14

    Article  PubMed  Google Scholar 

  82. Viestenz A (2004) Aderhautruptur nach Bulbuskontusion—eine Analyse anhand des Erlanger Okulären Contusions-Registers (EOCR). Klin Monatsbl Augenheilkd 221:713–719

    Article  CAS  PubMed  Google Scholar 

  83. Vinger PF (2002) Injury to the postsurgical eye. In: Kuhn F, Pieramici DJ (ed) Ocular trauma. Principle and practice. Thieme, New York S 280–292

  84. Waubke TN (1975) Traumatische Maculaaffektion. In: Jaeger W (Hrsg) Erkrankungen der Makula. Ber Dtsch Ophthalmol Ges. 73. Bergmann, München, S 683–691

  85. Weidenthal DT, Schepens CL (1966) Peripheral fundus changes associated with ocular contusion. Am J Ophthalmol 62:465–477

    Google Scholar 

  86. Weinstock SJ, Morin JD (1976) Traumatic macular hole. Can J Ophthalmol 11:249–251

    CAS  PubMed  Google Scholar 

  87. Wenzel M, Aral H (2003) Gedeckte Bulbusruptur. Klin Monatsbl Augenheilkd 220:35–38

    Article  PubMed  Google Scholar 

  88. Wessing A, Laqua H (1984) Kontusionsverletzungen am hinteren Augenabschnitt. Fortschr Ophthalmol 81:395–400

    Google Scholar 

  89. Wilhelm H (2002) Traumatologie des Sehnerven. In: Rohrbach JM, Steuhl KP, Knorr M, Kirchhof B (Hrsg) Ophthalmologische Traumatologie. Textbuch und Atlas. Schattauer, Stuttgart, S 142–150

  90. Witmer R (1972) Die traumatische Amotio retinae. Mod Probl Ophthalmol 10:361–375

    CAS  PubMed  Google Scholar 

  91. Wolff E (1935) Pathology of the eye. Philadelphia, The Blakiston Company, Philadelphia, p 149

  92. Wolter JR (1963) Coup-contrecoup mechanism of ocular injuries. Am J Ophthalmol 56:785–796

    CAS  PubMed  Google Scholar 

  93. Wyszynski RE, Grossniklaus HE, Frank KE (1988) Indirect choroidal rupture secondary to blunt ocular trauma. A review of eight eyes. Retina 8:237–243

    CAS  PubMed  Google Scholar 

  94. Yanagiya N, Akiba J, Takahashi M et al. (1996) Clinical characteristics of traumatic macular holes. Jpn J Ophthalmol 40:544–547

    CAS  PubMed  Google Scholar 

  95. Zion VM, Burton TC (1980) Retinal dialysis. Arch Ophthalmol 98:1971–1974

    Google Scholar 

Download references

Interessenkonflikt:

Der korrespondierende Autor versichert, dass keine Verbindungen mit einer Firma, deren Produkt in dem Artikel genannt ist, oder einer Firma, die ein Konkurrenzprodukt vertreibt, bestehen.

Author information

Authors and Affiliations

  1. Augenklinik mit Poliklinik der Universität Erlangen-Nürnberg, Erlangen

    A. Viestenz

  2. Augenpraxisklinik, Erlangen

    M. Küchle

  3. Augenklinik mit Poliklinik der Universität Erlangen-Nürnberg, Schwabachanlage 6, 91054 , Erlangen

    A. Viestenz

Authors
  1. A. Viestenz
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M. Küchle
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to A. Viestenz.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Viestenz, A., Küchle, M. Stumpfes Augentrauma. Ophthalmologe 102, 89–101 (2005). https://doi.org/10.1007/s00347-004-1137-7

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00347-004-1137-7

Schlüsselwörter

Keywords

Search

Navigation