Orbital Injury Flashcards
If you suspect an open globe (eyeball), what do you do?
Protect the eye so that the contents are not squeezed out
Which two bones of the orbital cavity are likely to get fractured?
- Ethmoid
- Maxillary
Define subcutaneous emphysema of the eyelid
Swollen eyelid with subcutaneous nodules (cannot blow nose; prescribe abx)
(may be caused by an ethmoid bone fracture)
_____ % of patients with orbital fracture also have an injury to the globe
4-11%
Corneal laceration with protruding iris
(notice the pupil is pointing toward the defect)
Define subluxated lens
Zonules are torn from the eye
(you can see the edge of the lens, urgent referral to ophthalmologist)
Foreign body in the eye
(you cannot see glass fragments in the eye)
How do patients acquire UV keratits?
- welding
- skiing w/o sunglasses
- sunlamp suntannig face
How to examine orbital injuries
- History
- External exam
- Visual acuity testing
- Ocular motility
- Pupillary reactivity
- Ophthalmoscopy
- Radiologic study
What are two true ocular emergencies?
- Central retinal artery occlusion
- Alkali burn
What should a patient do if they have an Alkali burn to the eye?
Irrigate immediately with a hose or have them dunk their head underwater repeatedly opening their eyes when they come back up.
(alkali = in cement, liquid plumber)
What do you do if bleach gets into your eye?
Irrigate
(They can cause red eye but it is not a strong alkali (it is hypochlorite))
What do you do if a patient has Central retinal artery occlusion?
- Have them breathe into a paper bag→ this will create an increase in CO2→ constriction of the arterioles
- Press on their eyeball→ attempting to move the occlusion
Urgent ocular injury referrals
- Open Glow
- Hyphema
- Lid laceration
- Radiant energy burn
- Traumatic optic neuropathy
Note how white the sclera is. Alkali burned the vessels.
(emergency!)
What happens at The Alkali burn does not heal?
Collageanouse activity of the cornea will melt the cornea→ Perforates the cornea
(acid burns are not the same.
How do you perform a foreign body removal?
- Anesthetizes the cornea
- Use a wet cotton swab and sweep out the foreign body or a strong stream of irrigating water
- If the object is lodged in the orbit, a sharper instrument may be needed and referral to an ophthalmologist to remove the object.
- Abx every 4 hours
- F/u in 1 day
(once anesthetic wears off, they will still feel like its there due to the corneal abrasion)
How do you remove a metallic foreign body that has been lodged in the cornea for more than 12 hours?
- Needle
- Abx
- Patch
- F/u daily
(must remove the rust ring and the metalic object)
More than ______ subconjunctival hemorrhages in year = referral to ophthalmologist
4
(they take about 2 weeks to heal)
Treatment for lid laceration
- Lacerations can be sutured if they are no full thickness laceration of the eyelid or involving the canaliculi.
(If either has occured → refer them to an opthalmologist to protect the canaliculi)
How do you irrigate the eye
- Irrigate using a plastic squeeze bottle of normal saline
- Irrigation on the lower lid (not the cornea)
- Any chemical irritant requires immediate and profuse irrigation aimed away from the good eye.
- Check the pH, and keep irrigating even until the pH is neutralized
How do you patch an eye?
You want to patch from opposite forehead to the front of the same ear
(avoid going to far toward the mouth so it does not loose integrity when they chew)
How would you examine this?
- Visual acuity (anesthetize first, minimize pressure on the globe, count fingers at 5 feet if they can’t keep it open)
- Pupillary reaction
- Extraocular motility (can move L/R, Up/Down)
2 types of traumatic orbital hemorrhage
- Preseptal
- Postseptal
How do you treat this before surgery?
Moisten the cornea with ointment (prevent infection or perforation)
(post-septal orbitral hemorrhage)
How is a eyelid laceration treated?
Suture
(Unless it is a full thickness tear which is referred to the ophthalmologist)
Inability to supraduct or elevate the eye with facial and teeth numbness indicates _____.
Orbital floor fx→ neuropathy of in for orbital nerve
(Infraorbital nerve runs along the maxillary bone in the floor of the orbit. Inferior rectus m. entrapped)
Blowout fracture of the orbit
Forced duction test
You can attempt to manually pull the contents of the orbit back into the eye
How will you know if the forced duction test successfully treated a blowout fracture?
- No diplopia
- Normal movements of the eyes (inferior rectus m. is free of entrapment)
- No more than 2 mm of enophthalmus
- Vision is good
(otherwise → surgery)
How is the orbital floor repaired after a blowout fracture?
Take cartilage from the ear or plastic→ reconstitute the orbital floor after you elevate the contents of the orbit out of the sinus
Treatment?
- Protect
- Send to ophthalmologist
(do NOT pull this out, it must be removed during surgery)
2 most damaging sports to the eye
- Racquetball
- Tennis ball
(the smaller the ball, the more important. Always educate patients on this!)
Teardrop-shaped pupil (usually associated with flat anterior chamber). What do you look for?
- Perforated ocular injury
- Look for uveal tissue where the teardrop pupil is pointing
Tear drainage goes from the medial aspect of th eye via the _____ of the eyelids and into the nose
puncta
(You need to recognize when the caniuli are lacerated to prevent chronic tearing)
Irregular pupil is a common aspect of _________.
corneal perforation as the iris will prolapse into the wound (pupil points towards the wound)
Which parts of the eye do not have no susceptive nerve endings?
- Lens
- Choroid
- Retina
