EYE TRAUMA

Question 1

Critical DDx

Answer 1

Ocular Compartment Syndrome
Entrapment (Orbital Blow Out)
Globe Rupture
Penetrating Eye Trauma
Lid margin Laceration
Lacrimal Duct Laceration

Question 2

DOCUMENTATION

Answer 2

HISTORY

Ask about:

Mechanism of injury
Timing of injury
Use of protective gear
Eye pain / foreign body sensation
Visual change
Diplopia
Facial Numbness
Changes in dental occlusion
Nausea / Vomit (oculocardiac reflex)

PHYSICAL

Check for bradycardia

Inspect for:

Periorbital ecchymosis, obvious facial fracture, lacerations, foreign bodies

Lashes, lids, lacrimal ducts, conjunctiva, sclera

Palpate facial structures for instability

Eye Exam:

Pupillary shape, size, response, EOM

Proptosis, enophthalmos

Hyphema

VA

IOP (if no concern for globe rupture)

Slit Exam:

Hyphema

Fluroexcein exam for Seidel sign, corneal laceration

Question 3

MANAGEMENT

Answer 3

IMAGING

Noncontrast computed tomography (CT) scan (face/orbit)

ORBITAL FRACTURE

Conservative management, follow up within 2 weeks

Indications for immediate repair:
Oculocardiac Reflex (bradycardia, nausea, vomiting)
Muscle Entrapment
Significant Enophalmos

Up to 29% of orbital fractures will have associated ocular injuries.

OPEN GLOBE
Urgent surgical repair
Elevate Head of Bed
Eye Shield
PPX antibiotics:
Fluoroquinolones
High Risk Injuries:
Vancoycin
Ceftazidime

ORBITAL COMPARTMENT SYNDROME
Lateral canthotomy