Ocular Trauma

Question 1

red eye presentations should be categorised into

Answer 1

traumatic and non-traumatic
this can be ellicited from the history

Question 2

blanched conjuntiva

Answer 2

porcelian eye
ischaemic

Question 3

alkaline agenst

Answer 3

cleaning, plaster, mortar, cement, fertiliser, airbags

Question 4

device to wash out eyes

Answer 4

morgan lens

Question 5

management of chemical injury

Answer 5

topical anaesthetic, lid eversion and sweep, irrigation,
oral analgesia, pH strips
urgent ophthalmology referral: topical ABs, cycloplegics, artificial tears, steroids, topical ascorbic acid, oral doxycycline and vitamin C, surgery

Question 6

orbital floor fracture

Answer 6

may trap the inferior rectus
causes an eye to fail to look up

Question 7

Hx of orbital fracture

Answer 7

acute trauma, pain and blurring
vertical diplopia
nosebleed
protective eyewear

Question 8

examination of orbital fracture

Answer 8

peri-orbital ecchymosis, diplopia on upgaze,
bradycardia
normal IOP
mild dilated pupil (traumatic mydriasis)

Question 9

traumatic midriasis

Answer 9

when the pupil is dilated following trauma

Question 10

management of isolated orbital floor injury

Answer 10

nasal decongestants
avoid nose blowing
rest
analgesia
ice packs
broad spectrum antibiotics to prevent orbital infection due to direct access to the sinuses

Question 11

retrobulbar haemorrhage history

Answer 11

severe acute trauma
rapid loss of vision
anticoagulants

Question 12

aetiology of retrobulbar haemorrhage

Answer 12

orbital compartment syndrome

Question 13

examination of retrobulbar haemorrhage

Answer 13

proptosis, peri-orbital ecchymoses, subconjunctival haemoglobin, retracted EOM
raised or unrecognisable IOP, RAPD, hyphaema

Question 14

management of retrobulbar haemorrhage

Answer 14

urgent lateral canthotomy/cantholysis
urgent CT orbitus/brain
urgent referral to ophthalmology
broad spectrum antibiotics, analgesia, IV acetazolamide +/- hydrocortisone

Question 15

penetrating eye injury

Answer 15

acute trauma, pain, loss of vision
tear drop pupil
tissue prolapsing through the eye

Question 16

penetrating eye injury on examination

Answer 16

shallow anterior chamber
sidle sign +ve, when you put fleeuroscene on the eye fluid will be seen leaking out of the site of penetration
uveal prolapse (the iris tissue may plug to would and prevent it from being siedel positive)

Question 17

management of penetrating eye injury

Answer 17

use a shield not a pad
urgent ophthalmology referral
fast for theatre, CT orbits/brain
tetanus injection, IVABs

Question 18

why can’t you ultrasound the eye in a penetrating eye injury

Answer 18

because an US involves pressure on the eye