Ophthalmological trauma Flashcards
What is an orbital fracture
Orbital fractures, commonly resulting from blunt force trauma to the face, involve the fracturing of the orbital wall due to a sudden increase in orbital pressure.
How does an orbital fracture occur?
Blunt force trauma to face - punch, assaults, car accidents, sporting injuries
Signs and symptoms of orbital fracture
Pain, particularly on eye movement
Swelling and bruising (lid ecchymosis) around the eye
Visual disturbancesDecreased eye movement
Numbness - decreased sensation of cheek and lips from damaged nerves
HALLMARK SIGN - Vertical diplopia and restriction of UPGAZE - can occur due to entrapment the inferior rectus muscle!!!
Investigations and treatment for orbital fracture
Suspected orbital fractures - computed tomography (CT) to identify the location and extent of the fracture - shows tear drop sign
Ophthalmology referral
Antibiotics
Nasal decongestants
Ice packs
Surgery may be used in severe cases or if the fracture does not improve with conservative management
DO NOT BLOW NOSE - can raise pressure and cause more material to move into sinuses
What is retrobulbar haemorrhage and when does it happen
Accumulation of blood in the retrobulbar space
Orbital trauma, anticoagulation, post eye surgery, arteriovenous malformation
Symptoms of retrobulbar haemorrhage
Pain, periorbital ecchymosis, eyelid haematoma, proptosis, visual loss, subconjunctival haemorrhage, nausea, vomitting
Treatment for retrobulbar haemorrhage
Clinical diagnosis - don’t wait for CT
Surgical treatment - lateral canthotomy with cantholysis within 2 hour of onset of proptosis or visual loss
Can give IV acetozolamide or hydrocortisone to decrease pressure
What causes globe rupture and what pathophysiologies does it cause?
Trauma
Retinal damage
Choroid damage
Lens dislocation
Ocular herniation
What are the signs and clinical features of globe rupture
Pain
Loss of vision
Diplopia
Distorted shape of globe
Herniation through sclera visible
Seen clearly with fluorescein dye
Investigation and treatment for globe rupture
CT orbit
Treatment
EYE PATCH CONTRAINDICATED
Use fox shield instead
Antiemetics
Antibiotics
Tetanus prophylaxis
Ophthalmology treats
Sign in history taking for penetrating eye injuries
History of hammering / work involving metal - were they using protective eye wear
Investigation and assessment for penetrating eye injury
Assessment
CHECK VISUAL ACUITY
Pupil irregularity
Puncture or entry wounds
Hyphaema
Vitreous haemorrhage
Investigation
X ray
Penetrating eye injuries treatment
Analgesia
Tetanus prophylaxis
IV antibiotics
Refer to optho
Do not move or try to remove embedded objects
Types of corneal trauma
Conjunctival foreign bodies
Subtarsal foreign bodies
Corneal foreign bodies
What is conjunctival foreign body and how is it removed
Type of corneal trauma - dust or grit bown into eye by wind
FB usually moves into and found in lower fornix - removed with cotton bud
What is subtarsal foreign body, presentation and how is it removed
Type of corneal trauma where FB stays stuck in upper eyelid
pain on blinking and fluorescein staining may show vertical corneal abrasians “ice rink”
Evert upper eye lid and remove with cotton bud, give topic antibiotics (fusidic eye drops or chloramphenical ointment)
How is corneal foreign body removed
LOCAL ANAESTHETIC GIVEN
Remove with cotton bud
If failed to remove, remove with needle
Prescribe antibiotic ointment after and refer if FB was large or rust ring left behind
Corneal abrasian symptoms
Irritation
Photophobia
Lacrimation
Corneal abrasian treatment
local anaesthetic drops and fluorescein staining to examine cornea
If not FB or penetrating injury, antibiotic ointment and oral analgesia
Eye patch
Do not drive until back to normal
What is Arc (welder’s) eye / snowblindness?
Exposure to UV light causing superficial keratitis
Presentation and treatment for Arc eye
Usually in climbers/skiers and sunbed users that don’t use protective goggles
Pain, watering and blepharospasm
drop of cyclopentolate or diclofenac into both eyes, eye pad, oral analgesia and do not drive - should resolve into 24 hrs
Management of chemical eye burns
Triage, refer immediately, check toxbase, lukewarm normal saline immediately until pH returns to normal
Saline
Irrigation if needed with local anaesthetic
Superglued eyelids management
Wash it warm water - should open within 4 days
Refer to ophthalmologist if pt feels FB