Orbital trauma

Revision as of 21:07, 20 November 2018 by Rossdonaldson1 (talk | contribs) (Differential Diagnosis)


  • 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

Differential Diagnosis

Maxillofacial Trauma

Unilateral red eye

^Emergent diagnoses

^^Critical diagnoses


  • Slit-lamp exam with fluorescein
    • Check for:
      • Abrasion
      • Laceration
      • Ulceration
      • Foreign body
      • Hyphema
      • Hypopion
      • Iritis
      • Lens dislocation
      • Globe rupture
  • Consider non-contrast face/orbital CT
  • Consider ocular ultrasound (if no suspicion for globe rupture)


  • Based on specific injury


  • Depends on specific injury

External Links

See Also