Ophthalmological trauma

Question 1

What is an orbital fracture

Answer 1

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.

Question 2

How does an orbital fracture occur?

Answer 2

Blunt force trauma to face - punch, assaults, car accidents, sporting injuries

Question 3

Signs and symptoms of orbital fracture

Answer 3

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!!!

Question 4

Investigations and treatment for orbital fracture

Answer 4

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

Question 5

What is retrobulbar haemorrhage and when does it happen

Answer 5

Accumulation of blood in the retrobulbar space

Orbital trauma, anticoagulation, post eye surgery, arteriovenous malformation

Question 6

Symptoms of retrobulbar haemorrhage

Answer 6

Pain, periorbital ecchymosis, eyelid haematoma, proptosis, visual loss, subconjunctival haemorrhage, nausea, vomitting

Question 7

Treatment for retrobulbar haemorrhage

Answer 7

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

Question 8

What causes globe rupture and what pathophysiologies does it cause?

Answer 8

Trauma

Retinal damage
Choroid damage
Lens dislocation
Ocular herniation

Question 9

What are the signs and clinical features of globe rupture

Answer 9

Pain
Loss of vision
Diplopia
Distorted shape of globe
Herniation through sclera visible

Seen clearly with fluorescein dye

Question 10

Investigation and treatment for globe rupture

Answer 10

CT orbit

Treatment
EYE PATCH CONTRAINDICATED
Use fox shield instead
Antiemetics
Antibiotics
Tetanus prophylaxis
Ophthalmology treats

Question 11

Sign in history taking for penetrating eye injuries

Answer 11

History of hammering / work involving metal - were they using protective eye wear

Question 12

Investigation and assessment for penetrating eye injury

Answer 12

Assessment
CHECK VISUAL ACUITY
Pupil irregularity
Puncture or entry wounds
Hyphaema
Vitreous haemorrhage

Investigation
X ray

Question 13

Penetrating eye injuries treatment

Answer 13

Analgesia
Tetanus prophylaxis
IV antibiotics
Refer to optho

Do not move or try to remove embedded objects

Question 14

Types of corneal trauma

Answer 14

Conjunctival foreign bodies
Subtarsal foreign bodies
Corneal foreign bodies

Question 15

What is conjunctival foreign body and how is it removed

Answer 15

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

Question 16

What is subtarsal foreign body, presentation and how is it removed

Answer 16

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)

Question 17

How is corneal foreign body removed

Answer 17

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

Question 18

Corneal abrasian symptoms

Answer 18

Irritation
Photophobia
Lacrimation

Question 19

Corneal abrasian treatment

Answer 19

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

Question 20

What is Arc (welder’s) eye / snowblindness?

Answer 20

Exposure to UV light causing superficial keratitis

Question 21

Presentation and treatment for Arc eye

Answer 21

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

Question 22

Management of chemical eye burns

Answer 22

Triage, refer immediately, check toxbase, lukewarm normal saline immediately until pH returns to normal
Saline
Irrigation if needed with local anaesthetic

Question 23

Superglued eyelids management

Answer 23

Wash it warm water - should open within 4 days

Refer to ophthalmologist if pt feels FB