Orbital trauma

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

1. Anterior chamber is flat
   1. Ruptured globe is certain
   2. Stop the exam; place eye shield, consult ophtho
2. Hyphema
   1. Evidence of significant trauma; consult ophtho
3. Extra-ocular movements
   1. Restricted upgaze or lateral gaze suggests Orbital Fracture w/ entrapment
      1. Obtain CT face
4. Orbital Rim
   1. Feel for step-off
5. Sensation
   1. Test along distribution of inf orbital nerve (below eye and ipsilateral side of nose)

Diagnosis

1. Slit-lamp exam w/ fluorescein
   1. Check for:
      1. Abrasion
      2. Laceration
      3. Foreign body
      4. Hyphema
      5. Iritis
         1. Pupil may be constricted or dilated
      6. Lens dislocation
      7. Globe rupture
         1. +Seidel test
         2. Full-thickness laceration

Disposition

1. Ophtho in 48hr if vision and ocular anatomy are preserved

See Also

• Orbital Fracture
• Traumatic Hyphema
• Retrobulbar Hematoma