Eye Trauma Flashcards
What are the two rules of globe rupture?
1) if suspected, DO NOT apply pressure to eye including avoiding eyelid retraction or tonometry
2) do not place meds such as tetracaine or fluorescein into eye
What is the clinical presentation of periorbital cellulitis?
gradual ONSET of URI, rhinitis, facial pressure, fever, redness and swelling of eyelid, excessive tearing, erythema eye not involved
What is the cause of periorbital cellulitis?
URI, eyelid problems, staph aureus, staph epidermidis, strep, anaerobes, infection of eyelids and periocular tissue
What’s the clinical presentation of orbital cellulitis?
gradual ONSET of URI, rhinitis, facial pressure, fever
pain with eye movement, limited EOM, chemosis, proptosis, abnormal pupil response, decreased visual acuity
What is the diagnosis procedure for periorbital cellulitis?
CT if ocular motility issues or orbital involvement
How do you treat periorbital cellulitis?
Augmentin or 1st gen cephalosporin
Hot packs, close follow up
Severe: opthalmology
What is the cause of orbital cellulitis?
infection of orbital soft tissues (paranasal sinusitis; ethmoid sinus MC), trauma, FB, spread of skin, surgery
Polymicrobial: staph aureus, strep pneumo, anaerobes
What should you consider for orbital cellulitis when concerned regarding headache and fever?
Cavernous sinus thrombosis with III, IV, VI associated with headache and fever. CT scan if concerned
What is the treatment of orbital cellulitis?
IV nafcillin AND metronidazole or clindamycin
add:
if trauma was underlying, cephalosporin (cefazolin or ceftriaxone)
if MRSA is a concern, add vancomycin or clindamycin
if penicillin sensitivity, vancomycin, levoflox, or metronidazole
What is the clinical presentation of a globe rupture?
decreased visual acuity, RAPD, eccentric or teardrop pupil
extrusion of vitreous fluid
external prolapse of uvea (eww)
Tenting, low IOP
Who have globe ruptures more commonly?
males
What are causes of globe rupture?
blunt, penetrating trauma; increased IOP, eye infections, post-op complications
What helps diagnose a globe rupture?
Gross deformity of eye without obvious volume loss
Need CT non contrast or xray
No MRI, no ultrasound
Positive Seidel sign = fluorescein streaming in tear drop
What’s the treatment for a globe rupture?
emergency!! avoid putting anything in eye or increasing IOP w/o ophthalmology
bandage eye (rest on FACE)
elevate bed
KEEP EYE STILL antiemetics, pain control, sedation (avoid ketamine)
IV antibiotics vancomycin and ceftazidime
may require surgery
What’s the clinical presentation of hyphema?
blood or blood clots in chamber, decreased visual acuity, eye pain with pupillary constriction
adjacent structure damage or abnormal IOP
What is a risk factor for hyphema?
sickle cell disease, bleeding disorders
What causes hyphema?
blunt or penetrating injury to the eye
What helps diagnose hyphema?
exclude open globe injury!!
IF OPEN GLOBE: CT
slit lamp
measure IOP & US only once open globe is excluded
How do you manage hyphema?
prevent rebleed and intraocular HTN, elevate patients, consult opthamologist
antifibrinolytic agents (stop breakdown of clotting)
oral/systemic aminocaproic acid, tranexamic acid, aminomethylbenzoic acid
corticosteroids
cycloplegics
miotics
aspirin
What is a subconjunctival hemorrhage?
painless rupture of blood vessels, mostly caused by trauma of sneezing, coughing, vomiting, hard bowel movements, contact lenses HTN, diabetes, coagulopathy
What is another type of subconjunctival hemorrhage?
bullous = ballooning and suspect open globe (CT scan)
What is the treatment for subconjunctival hemorrhage?
monitor, reassurance, usually resolves!
concern if recurrent (bleeding disorder?)
What is the clinical presentation of orbital fracture?
bony tenderness and swelling, periocular ecchymosis, diplopia (double vision), decreased sensation, orbital emphysema, crepitus of a fracture into a sinus
Where is the most common orbital fractures?
MC zygomatic, floor=ethmoid/maxillary “blowout”, small round object strikes eye most commonly
What is the diagnosis process for orbital fracture?
check acuity, proptosis = orbital hematoma
CT scan to check for: fracture, limitation of extraocular movement, decreased visual acuity, severe pain
What is the treatment of orbital fracture?
address life-threatening situations!! Airway!!!
Consult ophthalmology, may need surgery!
cephalexin and with patients of extraocular limitation, oral corticosteroids to reduce swelling
