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

• 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

Differential Diagnosis

Maxillofacial Trauma

• Ears
  • Auricular hematoma
• Nose
  • Nasal fracture
  • Nasal septal hematoma
• Oral
  • Dental trauma
  • Lip laceration
  • Tongue laceration
• Other face
  • Le Fort fractures
  • Mandible fracture
• Zygomatic arch fracture
• Zygomaticomaxillary (tripod) fracture
• Related
  • Head trauma (main)
    • Skull fracture
    • Skull fracture (peds)
    • Basilar skull fracture
  • Orbital trauma
    • Eyelid laceration
  • Scalp laceration

Diagnosis

• 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
• [Ocular ultrasound]]
  • Can be done AFTER open globe has been ruled out
  • Check for: retinal detachment, vitreous hemoarrhage/detachment

Disposition

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

See Also

• Maxillofacial trauma