Orbital trauma: Difference between revisions
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==Clinical Features== | ==Clinical Features== | ||
*Anterior chamber is flat +/- abnormal pupil | *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 | ||
*Hyphema | *[[Hyphema]] | ||
**Evidence of significant trauma; consult ophtho | **Evidence of significant trauma; consult ophtho | ||
*Extra-ocular movements | *Extra-ocular movements | ||
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*Photophobia | *Photophobia | ||
**If photophobia in affected and unaffected eye, suspect traumatic iritis | **If photophobia in affected and unaffected eye, suspect traumatic iritis | ||
*Decreased visual acuity +/- proptosis | *[[vision loss|Decreased visual acuity]] +/- proptosis | ||
**Clinically suspect [[Orbital Hematoma]], check IOP if open globe has been ruled out | **Clinically suspect [[Orbital Hematoma]], check [[intraocular pressure|IOP]] if open globe has been ruled out | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
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*[[Slit-lamp]] exam with fluorescein | *[[Slit-lamp]] exam with fluorescein | ||
**Check for: | **Check for: | ||
***Abrasion | ***[[corneal abrasion|Abrasion]] | ||
***Laceration | ***Laceration | ||
***Ulceration | ***[[corneal ulcer|Ulceration]] | ||
***Foreign body | ***[[ocular foreign body|Foreign body]] | ||
***Hyphema | ***Hyphema | ||
***Hypopion | ***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]] (if no suspicion for globe rupture) | *Consider [[ocular ultrasound]] (if no suspicion for globe rupture) | ||
Revision as of 18:17, 28 September 2019
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
Unilateral red eye
- Nontraumatic
- Acute angle-closure glaucoma^
- Anterior uveitis
- Conjunctivitis
- Corneal erosion
- Corneal ulcer^
- Endophthalmitis^
- Episcleritis
- Herpes zoster ophthalmicus
- Inflamed pinguecula
- Inflamed pterygium
- Keratoconjunctivitis
- Keratoconus
- Nontraumatic iritis
- Scleritis^
- Subconjunctival hemorrhage
- Orbital trauma
- Caustic keratoconjunctivitis^^
- Corneal abrasion, Corneal laceration
- Conjunctival hemorrhage
- Conjunctival laceration
- Globe rupture^
- Hemorrhagic chemosis
- Lens dislocation
- Ocular foreign body
- Posterior vitreous detachment
- Retinal detachment
- Retrobulbar hemorrhage
- Traumatic hyphema
- Traumatic iritis
- Traumatic mydriasis
- Traumatic optic neuropathy
- Vitreous detachment
- Vitreous hemorrhage
- Ultraviolet keratitis
^Emergent diagnoses ^^Critical diagnoses
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