Orbital trauma: Difference between revisions
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***Abrasion | ***Abrasion | ||
***Laceration | ***Laceration | ||
***Ulceration | |||
***Foreign body | ***Foreign body | ||
***Hyphema | ***Hyphema | ||
***Hypopion | |||
***Iritis | ***Iritis | ||
***Lens dislocation | ***Lens dislocation | ||
***Globe rupture | ***Globe rupture | ||
*Consider non-contrast face/orbital CT | *Consider non-contrast face/orbital CT | ||
*Consider [[ocular ultrasound]] | *Consider [[ocular ultrasound]] (if no suspicion for globe rupture) | ||
==Management== | ==Management== | ||
*Based on specific injury | |||
==Disposition== | ==Disposition== | ||
* | *Depends on specific injury | ||
==External Links== | ==External Links== | ||
| Line 56: | Line 54: | ||
==See Also== | ==See Also== | ||
*[[Maxillofacial trauma]] | *[[Maxillofacial trauma]] | ||
==References== | |||
<references/> | |||
[[Category:Ophthalmology]] | [[Category:Ophthalmology]] | ||
[[Category:Trauma]] | [[Category:Trauma]] | ||
Revision as of 10:37, 18 November 2017
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
Maxillofacial Trauma
- Ears
- Nose
- Oral
- Other face
- Zygomatic arch fracture
- Zygomaticomaxillary (tripod) fracture
- Related
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