Blow Out Fracture

Question 1

Most common young unilateral cataract

Answer 1

Stellate posterior from trauma

Question 2

When dealing with new diplopia due to trauma, what should you do?

Answer 2

Wait 10-14 days to see if it will resolve before trying to treat it

Question 3

When is it best to dx enophthalmos?

Answer 3

10-14 days. Sometimes orbital edema will mask it

Question 4

All things orbital floor fracture

Answer 4

• order CT scan of orbits
• check for enophthalmos, diplopia in primary and upgaze, crepitus, hypoasthesia
• prophylactic oral abx may be RXed and avoid nose blowing for 4-6 weeks (?48 hours)
• surgical managemnt may be required if enophthalmos or diplopia do not resolve and pt is symptomatic
• both enophthalmos and diplopia May resolve on their own. Usually wait 2 weeks before deciding surgical management

Question 5

What is a contraindication for MRI

Answer 5

Metal

MRI is better for soft tissue instead of bone

Question 6

Most common location for a blowout fracture of the orbit

Answer 6

Maxillary bone in the orbital floor, it is the weakest bone in the orbit

Question 7

What should someone with a suspected orbital blow out fracture be evaluated for

Answer 7

• EOM restrictions
• crepitus
• infraorbital hypoasthesia
• step off
• exophthalmometry
• globe ptosis
• asymmetric monocular PDs

Question 8

Positive forced duction

Answer 8

The eye cannot be moved in the direction of the restriction. Physical restriction
-EOM entrapment, Duanes, Browns, orbital tumor, graves

Question 9

Negative forced duction

Answer 9

The eye passively moves in the direction of the restriction, indicating a CN palsy is the cause of the restriction

Question 10

What diff a CN palsy from a muscle restriction

Answer 10

Forced ductions

Question 11

What CN is most susceptible to trauma

Answer 11

CN4

Question 12

Characteristics of CN4 palsies

Answer 12

Large vertical vergence ranges

Presents with vertical diplopia and head tilt AWAY from the side of the lesions, as well as a chin down position

Question 13

Bielschowskys head tilt test

Answer 13

CN 4 palsy, a head tilt towards the affected side makes the diplopia worse; a head tilt away from the affected side males the diplopia decreased due to induced incyclotorsion

Question 14

What meds should you give someone with an orbital blow out fracture

Answer 14

Nasal decongestants and oral abx to prevent sneezing and to prevent an orbital infection. Cold compresses may also be used to decrease inflammation. Surgical report is indicated if diplopia presents for more than 7-14 days. Fresnel prism may be initally RXed in order to minimize diplopia

Question 15

Traumatic uveitis treatment

Answer 15

pred forte QID and homatropine BID