Trauma Flashcards
What is an orbital blow out fracture?
Fracture of the floor of the orbit
How does on orbital blow out fracture present?
History of blunt trauma
Pain, bruising, oedema
Pain on upgaze
Diplopia
What investigations can be done for an orbital blow out fracture and what would show?
CT
Tear drop sign (fat content spills into maxillary sinus)
How would a globe rupture present?
History of severe trauma
Boggy, oedematous appearance
Severe subconjunctival haemorrhage
What would onset of flashes/floaters and visual loss after trauma suggest?
Retinal detachment
What is commotio retinae?
Bruised retina
What do multiple vertical linear scratches on the eye suggest?
How would you manage this?
Subtarsal foreign body
Removal with slip-lamp
How would you manage a corneal foreign body?
Remove
Prophylactic chloramphenicol
Review a few days later (residual metal can form problematic ‘rust ring’)
What is the investigation of choice in suspected intra-ocular foreign body?
X-ray
What is and can cause hymphema?
With a penetrative history, what is the management of choice?
Blood in the anterior chamber
Surgery
What is sympathetic ophthalmia?
Bilateral granulomatous uveitis caused by unilateral trauma
What is the pathophysiology of sympathetic ophthalmia?
Poorly understood but thought to be related to immune privilege
Inflammatory T-cells activated by trauma to exciting eye act on both the exciting and sympathising eye
What is the general management of ocular chemical burns?
Quick history
Check pH
Urgent irrigation with minimum 2l until pH normal
What are the signs of alkaline ocular burns?
China white sclera (limbal ischaemia)
What are the signs of acidic ocular burns?
Opaque corneal scarring (opacity within cornea)
What chemicals should be physically removed rather than irrigated?
Quicklime/limestone
Cement
What is retinal detachment?
Mechanical separation of retina from the retinal pigment epithelium
What can cause retinal detachment?
Trauma
Spontaneous (common in myopes)
How does retinal detachment present?
Sudden painless loss of vision
Sudden osnet of
- flashes (mechanical stimulation of retina)
- floaters (proteins spill into vitreous fluid)
RAPD
What would you expect to see on fundoscopy in retinal detachment?
Wrinkles retina
Torn retina
How is retinal detachment managed?
Surgically
What indicated urgent management of a retinal tear?
Macular sparing
Urgent surgery to preserve the macula
