Ocular Trauma

Question 1

What trauma can PCPs take care of?

What trauma needs to be seen by ophthalmologist?

Answer 1

• Corneal abrasions can be taken care of by PCP.

* Ophthalmologist required for hyphema, orbital fracture, and open globe.

Question 2

Things to look for on exam (6)

Answer 2

Blood in anterior chamber, peaked pupil, eyelid laceration, integrity of cornea / sclera / conjunctiva, periocular ecchymoses, and entrapped muscle (EOM exam).

Question 3

Hyphema
What is it?
Which parts of the eye are still in tact?
Mechanism of injury
Visual loss
Pupils
EOM
Associated signs / sxs (4)
Treatment (4)

Answer 3

Hyphema = torn iris w/ blood in anterior chamber.
Cornea, sclera, and conjunctiva are intact.
Mechanism of injury - blunt
Visual loss - moderate / severe
Pupils - normal
EOM - normal
Associated signs / sxs - pain, light sensitivity, and decreased vision. Nausea / vomiting may occur if eye pressure is high.
Treatment - Requires urgent referral (same or next day). Eye drops, strict bed rest for 1 week (if scab breaks, whole eye may fill w/ blood again), shield (so px doesn’t rub it), no NSAIDS due to risk of further bleeding.

Question 4

Corneal abrasion
Mechanism of injury
Visual loss
Pupils
EOM
Associated signs / sxs (5)
Treatment

Answer 4

Mechanism of injury - scrape
Visual loss - mild
Pupils - normal
EOM - normal
Associated signs / sxs - pain (relieved w/ anesthetic), mild decreased vision, tearing, redness, and feeling of foreign body
Treatment – AB ointment or drops. Refer if more than mild trauma occurred or if not better in a couple days.

Question 5

Orbital fracture
Mechanism of injury
Visual loss
Pupils
EOM
Associated signs / sxs (5)
Diagnosis
Treatment

Answer 5

Mechanism of injury - blunt
Visual loss - none
Pupils - normal
EOM - abnormal due to entrapment of muscles (esp inferior rectus)
Associated signs / sxs - diplopia, periocular ecchymoses (bruising around eye), subconjunctival hemorrhage, swollen lids, and loss of sensation of upper cheek
Diagnose w/ CT scan. Maxillary sinus may be filled w/ fluid.
Treatment - Refer to ophthalmology today. Need to make sure the eye is intact and no retinal tear.

Question 6

Open globe
Mechanism of injury
Visual loss
Pupils
EOM
Associated signs / sxs (4)
Suspicious history (3)
What should you not do? (3)
Treatment (5)

Answer 6

Mechanism of injury - sharp or blunt
Visual loss - variable. May be severe.
Pupils - may be peaked
EOM - normal
Associated signs / sxs - shallow anterior chamber, pain, loss of sight, peaked pupil (cat’s eye)
Suspicious history - hammering, metal-on-metal, history of eye surgery (may rupture through old wound).
Do NOT place an eye patch b/c the pressure can extrude intraocular contents.
Do NOT perform any other eye examination if open globe is suspected.
Do NOT give eye drops.
Treatment includes shield, updated tetanus, NPO (may have to go to surgery), anti-emetic (throwing up increases pressure and may cause “squirting” out of the eyeball contents), and CT scan of orbits.

Question 7

What kind of general injury is associated w/ double vision?

Answer 7

Blunt injury