Optho Anatomy and Trauma

Question 1

Where is the blind spot?

Answer 1

15 deg lateral and 1 deg inferior

Question 2

7 orbital bones

Answer 2

Frontal
Zygomatic
Maxillary
Ethmoid
Sphenoid
Palatine
Lacrimal

Question 3

What imaging modality is helpful for diagnosing orbital fracture?

Answer 3

CT

Non contrast

Question 4

White eyed blowout fracture

Answer 4

In pediatric patients
The bone breaks, muscles get trapped, then bone snaps back in place
Bones look normal on CT
But there is impaired eye movements
Also causes oculocardiac reflex (bradycardia and HTN)
Short period of time to fix before muscle becomes ischemic

Question 5

Initial management of orbital fractures

Answer 5

Avoid valsalva and blowing nose
Analgesia and anti emetics
Opthalmic exam
Immediate surgery if the white eyed blowout fracture
Repair in 1-2 weeks if persistent diplopia or large fracture

Question 6

Retrobulbar hemorrhage

Answer 6

Blood, pus, or air can cause compartment syndrome

Ischemia of optic nerve, globe, or retina can occur

Question 7

Initial management of retrobulbar hemorrhage

Answer 7

Urgent ophthamology consultation
Want to lower intraorbital and intraocular pressure
If secondary to surgery, open sutures
If not secondary to surgery, then relieve orbital pressure by cutting side of eye to bone

Question 8

Orbital septum

Answer 8

Layer of fascia extending vertically from the periosteum of the orbital rim to the levator aponeurosis and inferior border of the tarsal plate

Question 9

Is preseptal cellulitis or orbital cellulitis worse?

Answer 9

Orbital cellulitis

The globe is in that compartment

Question 10

Retinal detachment

Answer 10

Separation of the inner layers of the retina from the underlying retinal pigment epithelium

Question 11

Should you measure intraocular pressure in a globe rupture?

Answer 11

No!
Dont want to push on the eye if there is a hole in it
But if you did the pressure would be low

Question 12

Traumatic optic neuropathy

Answer 12

Acute injury to the optic nerve due to trauma
Blunt force trauma causes indirect trauma to optic nerve, by shearing forces transmitted through optic canal
Penetrating injuries, bone fragments in the optic canal, or optic sheath hematomas can cause direct injury to optic nerve
Retribulbar hemorrhage is the most common cause of traumatic optic neuropathy
Poor prognosis

Question 13

Oculocardiac reflex

Answer 13

From WEBOF in pediatric patients

Bradycardia and HTN