Orbital trauma

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Background

  • Must assess:
    • Visual acuity
    • Anterior chamber
    • Integrity of globe
    • Pupil shape and reactivity
  • Use paperclip or eyelid speculum to open swollen eyes

Clinical Features

  • Anterior chamber is flat +/- abnormal pupil
    • Ruptured globe is certain
    • Stop the exam; place eye shield, consult ophtho
  • Hyphema
    • Evidence of significant trauma; consult ophtho
  • Extra-ocular movements
    • Restricted upgaze or lateral gaze suggests Orbital Fracture with entrapment
      • Obtain CT face
  • Orbital Rim
    • Feel for step-off
  • Sensation
    • Test along distribution of inf orbital nerve (below eye and ipsilateral side of nose)
  • Photophobia
    • If photophobia in affected and unaffected eye, suspect traumatic iritis
  • Decreased visual acuity +/- proptosis
    • Clinically suspect Orbital Hematoma, check IOP if open globe has been ruled out

Differential Diagnosis

Maxillofacial Trauma

Orbital trauma

Acute

Subacute/Delayed

Evaluation

  • Slit-lamp exam with fluorescein
    • Check for:
      • Abrasion
      • Laceration
      • Foreign body
      • Hyphema
      • Iritis
        • Pupil may be constricted or dilated
      • Lens dislocation
      • Globe rupture
        • +Seidel test
        • Full-thickness laceration
  • Consider non-contrast face/orbital CT
  • Consider ocular ultrasound

Management

Disposition

  • Ophtho in 48hr if vision and ocular anatomy are preserved

External Links

See Also