L15: Eye Trauma

Question 1

What is this sign called?

What is it indicative of?

Answer 1

Periorbital ecchymosis (“raccoon eyes”)

Anterior Fossa Fracture

Question 2

What is this sign called?

What is it indicative of?

Answer 2

Mastoid ecchymosis (Battle’s sign)

Middle Fossa Fracture

Question 3

What is this condition called?

Answer 3

Traumatic Mydriasis: damage to the sphincter pupillae muscle

Question 4

Condition in which a pupil does not constrict to light torch?

What can cause this?

Answer 4

Anisocoria

1. Traumatic mydriasis
2. Holmes Adie pupil
3. III nerve palsy
4. Argyll Robertson Pupil

Question 5

Condition involving relative afferent pupillary defect?

Test for this?

Answer 5

Marcus Gunn Pupil: in trauma, loss of function of optic nerve, loss of ipsilateral pupillary constriction

Swinging Flashlight Test: Sign of early threat to optic nerve, when light swung over from one side to the other=> dilation instead of constriction

Question 6

What is this condition?

Answer 6

Corneal Foreign Body

Question 7

What is the name of this device used in cases of chemical burns => constantly irrigates the eye

Answer 7

Morgan Lens

Question 8

What is this condition?

What should be done?

Lingering affects?

Answer 8

Hyphaema: blood in anterior chamber of the eye

Check intraocular pressure!

Should resolve in 5-6 days

Haemosiderosis (Brown staining) possible in long-standing cases

Question 9

SIGNS of Globe rupture?

Answer 9

• Subconjunctival hemorrhage
• Hyphaema: blood in anterior chamber of the eye
• Teardrop pupil or corectopia
• Loss of red reflex
• Shallow anterior chamber
• Positive Seidel test

Question 10

Major Bones of the Right Orbi

Answer 10

Question 11

Relationship of Orbital Fissures and Optic canal?

Answer 11

Optic Cannal is Medial to Fissures

Question 12

Roof of the Orbit?

Answer 12

Question 13

Floor of the Orbit?

Answer 13

Question 14

Medial wall of Right Orbit?

Answer 14

Question 15

Lateral Wall of the Right Orbit?

Answer 15

Question 16

Tethering point of extraocular muscles?

Answer 16

Annulus of Zinn

Question 17

Extraocular Muscles and their innervation?

• ALL Extracocular muscles innervated by ___________________
• Lateral Rectus: Innervated by __________________
• Superior Oblique: innervated by ___________________

Answer 17

Innervations:

• ALL Extracocular muscles innervated by CNIII (Oculomotor nerve)
• Lateral Rectus: Innervated by Abducens Nerve (CNVI)
• Superior Oblique: innervated by Trochlear Nerve (CNIV)

Question 18

Contents of Superior Orbital Fissure?

Answer 18

Question 19

Contents of Inferior Orbital Fissure?

Answer 19

Question 20

What do fractures of right temporal, sphenoid, and zygomatic bone lead to?

How doe this manifest?

Answer 20

Superior Orbital Fissure Syndrome

Question 21

What is occurring in this case?

Answer 21

Blow out fracture of orbit

• Periorbital ecchymosis
• Subconjunctival hemorrhage
• Eye not able to look up

Question 22

CT shows a depressed fracture of the ___________ (white arrow) and ___________ (arrowheads)

__________________ through the fracture (black arrow) which can act like a ball valve: trapping air in the orbit whenever nasal pressure rises and falls.

Answer 22

CT shows a depressed fracture of the ethmoid bone (white arrow) And orbital emphysema (arrowheads)

Herniation of orbital fat through the fracture (black arrow) which can act like a ball valve: trapping air in the orbit whenever nasal pressure rises and falls.

Question 23

Signs of Ethmoid Blowout?

Answer 23

Crepitus around the orbital rim.

Orbital Emphysema: patient sneezed => periorbital skin puffed out

Question 24

Treatment of Orbital compartment syndrome?

Answer 24

Emergency lateral canthotomy and cantholysis

• Pressure of eye should be <25 mm, if greater than 40 then in compartment syndrome!! (< 2 hours till optic nerve lost)