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 +/- abnormal pupil
   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)
6. Photophobia
   1. If photophobia in affected and unaffected eye, suspect traumatic iritis
7. Decreased visual acuity +/- proptosis
   1. Clinically suspect Orbital Hematoma, check IOP if open globe has been ruled out

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
2. Ultrasound: Occular
   1. Can be done AFTER open globe has been ruled out
   2. Check for: retinal detachment, vitreous hemoarrhage/detachment

Disposition

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

See Also

• Orbital Fracture
• Traumatic Hyphema
• Retrobulbar Hematoma