Orbital trauma: Difference between revisions
(clinical exam for eye trauma) |
(photophobia concerning for traumatic iritis) |
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| Line 8: | Line 8: | ||
==Clinical Features== | ==Clinical Features== | ||
#Anterior chamber is flat | #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 | ||
| Line 20: | Line 20: | ||
#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 | |||
## If photophobia in affected and unaffected eye, suspect traumatic iritis | |||
==Diagnosis== | ==Diagnosis== | ||
Revision as of 20:09, 31 December 2013
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
- Restricted upgaze or lateral gaze suggests Orbital Fracture w/ 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
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
- Check for:
Disposition
- Ophtho in 48hr if vision and ocular anatomy are preserved