Lec 4 Ocular trauma Flashcards
Flow of ocular trauma assessment
HGP
AID
P&E
Hx and VA
Gross examination, globe position and EOM
Pupils/other neuro
Anterior - up to ant vitreous
IOP using Icare
Vitreous/Fundus using DFE
Photos/OCT to document and enhance detection
Extra test - amsler/mono CV
When to asses Hx/VA
All trauma
When to do gross examination (direct observation with more light)
Periorbital trauma -lids and adnexae
Conjunctiva - laceration, haems, FB
When to assess globe position (asymmetry, position changes, globe pulsation)
Best with exophthalmometer and look from above all
Orbital floor fracture
Altered globe position - endopthalmos, proptosis, retrobulbar haems
When to assess EOM (looking for restrictions or incomitancy)
Orbital wall or floor fracture
When to assess pupils (irregular shape or RAPD)
Iris tears/dialysis, iridodonesis, uveitis, traumatic mydriasis
Vitreous and large retinal haems
ON damage
When to assess other neurological findings (paraesthesia or numbness)
Orbital rim or floor fracture
(Tickle inf cheek with tissue and if nothing = damage to nerve = damage to orbital floor = potential damage to sinus = orbital cellulitis
When to assess anterior slit lamp
Dyes, Seidel sign, gonio - CONTRAINDICATED IN ACTIVE HYPHEMA
Conjunctival trauma e.g laceration harm or FB
Corneal abrasion, penetration or FB
Chemical or toxic burn
Anterior chamber: hyphema, iris tear, iridodonesis, uveitis, traumatic mydriasis
Lens: dialysis, phakodonesis, subluxation
When to assess IOP
Most cases
Increase if uveitis and decreased if corneal or scleral perforation
When to DFE
Looking for intraocular FB
Vitreal and retinal haems
Commotio retinae
Traumatic macular hole
RRD, tears
ON damage
When to image - enhance detection and photo documentation
All Trauma
