Orbital trauma: Difference between revisions
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==Clinical Features== | ==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]] | **Restricted upgaze or lateral gaze suggests [[Orbital Fracture]] with entrapment | ||
***Obtain CT face | ***Obtain CT face | ||
*Orbital Rim | *Orbital Rim | ||
Line 21: | Line 21: | ||
**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 | *[[vision loss|Decreased visual acuity]] +/- proptosis | ||
**Clinically suspect [[Orbital Hematoma]], check IOP if open globe has been ruled out | **Clinically suspect [[Orbital Hematoma]], check [[intraocular pressure|IOP]] if open globe has been ruled out | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
{{Eye trauma}} | |||
{{Maxillofacial trauma DDX}} | {{Maxillofacial trauma DDX}} | ||
{{Unilateral red eye DDX}} | |||
== | ==Evaluation== | ||
*[[Slit-lamp]] exam with fluorescein | *[[Slit-lamp]] exam with fluorescein | ||
**Check for: | **Check for: | ||
***Abrasion | ***[[corneal abrasion|Abrasion]] | ||
***Laceration | ***Laceration | ||
***Foreign body | ***[[corneal ulcer|Ulceration]] | ||
***[[ocular foreign body|Foreign body]] | |||
***Hyphema | ***Hyphema | ||
*** | ***Hypopion | ||
*** | ***[[Iritis]] | ||
***Lens dislocation | ***[[Lens dislocation]] | ||
***Globe rupture | ***[[Globe rupture]] | ||
* | *Consider non-contrast face/orbital CT | ||
*Consider [[ocular ultrasound]] (if no suspicion for globe rupture) | |||
*[[ | |||
==Management== | ==Management== | ||
*Based on specific injury | |||
==Disposition== | ==Disposition== | ||
* | *Depends on specific injury | ||
==External Links== | |||
*[http://webeye.ophth.uiowa.edu/eyeforum/tutorials/trauma.htm EyeRounds Ocular Trauma] | |||
*[http://www.emdocs.net/em-cases-blunt-ocular-trauma/ emDocs Ocular Trauma] | |||
==See Also== | ==See Also== | ||
*[[Maxillofacial trauma]] | *[[Maxillofacial trauma]] | ||
==References== | |||
<references/> | |||
[[Category: | [[Category:Ophthalmology]] | ||
[[Category:Trauma]] | [[Category:Trauma]] |
Revision as of 21:28, 12 August 2020
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
- Restricted upgaze or lateral gaze suggests Orbital Fracture with entrapment
- 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
Orbital trauma
Acute
- Caustic keratoconjunctivitis^^
- Conjunctival hemorrhage
- Conjunctival laceration
- Corneal abrasion, Corneal laceration
- Globe rupture^
- Iridodialysis
- Lens dislocation
- Ocular foreign body
- Orbital fracture
- Frontal sinus fracture
- Naso-ethmoid fracture
- Inferior orbial wall fracture
- Medial orbital wall fracture
- Posterior vitreous detachment
- Retinal detachment
- Retrobulbar hemorrhage/hematoma
- Subconjunctival hemorrhage
- Traumatic hyphema
- Traumatic iritis
- Traumatic mydriasis
- Traumatic optic neuropathy
- Vitreous detachment
- Vitreous hemorrhage
- Ultraviolet keratitis
Subacute/Delayed
Maxillofacial Trauma
- Ears
- Nose
- Oral
- Other face
- Zygomatic arch fracture
- Zygomaticomaxillary (tripod) fracture
- Related
Unilateral red eye
- Nontraumatic
- Acute angle-closure glaucoma^
- Anterior uveitis
- Conjunctivitis
- Corneal erosion
- Corneal ulcer^
- Endophthalmitis^
- Episcleritis
- Herpes zoster ophthalmicus
- Inflamed pinguecula
- Inflamed pterygium
- Keratoconjunctivitis
- Keratoconus
- Nontraumatic iritis
- Scleritis^
- Subconjunctival hemorrhage
- Orbital trauma
- Caustic keratoconjunctivitis^^
- Corneal abrasion, Corneal laceration
- Conjunctival hemorrhage
- Conjunctival laceration
- Globe rupture^
- Hemorrhagic chemosis
- Lens dislocation
- Ocular foreign body
- Posterior vitreous detachment
- Retinal detachment
- Retrobulbar hemorrhage
- Traumatic hyphema
- Traumatic iritis
- Traumatic mydriasis
- Traumatic optic neuropathy
- Vitreous detachment
- Vitreous hemorrhage
- Ultraviolet keratitis
^Emergent diagnoses ^^Critical diagnoses
Evaluation
- Slit-lamp exam with fluorescein
- Check for:
- Abrasion
- Laceration
- Ulceration
- Foreign body
- Hyphema
- Hypopion
- Iritis
- Lens dislocation
- Globe rupture
- Check for:
- Consider non-contrast face/orbital CT
- Consider ocular ultrasound (if no suspicion for globe rupture)
Management
- Based on specific injury
Disposition
- Depends on specific injury