Orbital trauma: Difference between revisions

Revision as of 23:39, 28 April 2015

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 w/ 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

Diagnosis

Slit-lamp exam w/ fluorescein
- Check for:
  - Abrasion
  - Laceration
  - Foreign body
  - Hyphema
  - Iritis
    - Pupil may be constricted or dilated
  - Lens dislocation
  - Globe rupture
    - +Seidel test
    - Full-thickness laceration
Ultrasound: Ocular
- Can be done AFTER open globe has been ruled out
- Check for: retinal detachment, vitreous hemoarrhage/detachment

Differential Diagnosis

Maxillofacial Trauma

Ears
- Auricular hematoma
Nose
- Nasal fracture
- Nasal septal hematoma
Oral
Other face
- Le Fort fractures
- Mandible fracture
Zygomatic arch fracture
Zygomaticomaxillary (tripod) fracture
Related

Management

Disposition

Ophtho in 48hr if vision and ocular anatomy are preserved

@@ Line 8: / Line 8: @@
 ==Clinical Features==
-#Anterior chamber is flat +/- abnormal pupil
+*Anterior chamber is flat +/- abnormal pupil
-##Ruptured globe is certain
+**Ruptured globe is certain
-##Stop the exam; place eye shield, consult ophtho
+**Stop the exam; place eye shield, consult ophtho
-#Hyphema
+*Hyphema
-##Evidence of significant trauma; consult ophtho
+**Evidence of significant trauma; consult ophtho
-#Extra-ocular movements
+*Extra-ocular movements
-##Restricted upgaze or lateral gaze suggests [[Orbital Fracture]] w/ entrapment
+**Restricted upgaze or lateral gaze suggests [[Orbital Fracture]] w/ entrapment
-###Obtain CT face
+***Obtain CT face
-#Orbital Rim
+*Orbital Rim
-##Feel for step-off
+**Feel for step-off
-#Sensation
+*Sensation
-##Test along distribution of inf orbital nerve (below eye and ipsilateral side of nose)
+**Test along distribution of inf orbital nerve (below eye and ipsilateral side of nose)
-#Photophobia
+*Photophobia
-## If photophobia in affected and unaffected eye, suspect traumatic iritis
+** If photophobia in affected and unaffected eye, suspect traumatic iritis
-#Decreased visual acuity +/- proptosis
+*Decreased visual acuity +/- proptosis
-##Clinically suspect [[Orbital Hematoma]], check IOP if open globe has been ruled out
+**Clinically suspect [[Orbital Hematoma]], check IOP if open globe has been ruled out
 ==Diagnosis==
-#Slit-lamp exam w/ fluorescein
+*Slit-lamp exam w/ fluorescein
-##Check for:
+**Check for:
-###Abrasion
+***Abrasion
-###Laceration
+***Laceration
-###Foreign body
+***Foreign body
-###Hyphema
+***Hyphema
-###Iritis
+***Iritis
-####Pupil may be constricted or dilated
+****Pupil may be constricted or dilated
-###Lens dislocation
+***Lens dislocation
-###Globe rupture
+***Globe rupture
-####+Seidel test
+****+Seidel test
-####Full-thickness laceration
+****Full-thickness laceration
-#[[Ultrasound: Ocular]]
+*[[Ultrasound: Ocular]]
-##Can be done AFTER open globe has been ruled out
+**Can be done AFTER open globe has been ruled out
-##Check for: retinal detachment, vitreous hemoarrhage/detachment
+**Check for: retinal detachment, vitreous hemoarrhage/detachment
 ==Differential Diagnosis==
@@ Line 48: / Line 48: @@
 ==Disposition==
-#Ophtho in 48hr if vision and ocular anatomy are preserved
+*Ophtho in 48hr if vision and ocular anatomy are preserved
 ==See Also==