EYE TRAUMA AND EMERGENCIES

Question 1

What are blowout fractures of the orbit ?

Answer 1

These are fractures that cause herniation of retoribital content or entrapment of EOM.

Question 2

What is the history and presentation of blowout orbital fractures ?

Answer 2

The patients typically have an Hx of trauma and presents with visual impairment, cheek and gum numbness, Ptosis and periorbital echymosis and edema.

Question 3

What are the elements of blowout orbital fracture physical examination?

Answer 3

– Evaluate VA and pupil function to rule out optic nerve involvement.
- Evaluate EOM to rule out muscle entrapment and neuropathy.
– Slit lamp exam
* To evaluate for damage to the lids,
cornea, sclera, and lens and to
measure IOP
– Dilated funduscopic exam
* To evaluate for presence of posterior
segment damage

Question 4

What is the purpose of pre-surgical forced duction test ?

Answer 4

It is necessary to differentiate entrapment from third nerve palsy.

Question 5

what should be the time delay for surgery in blowout orbital fracture ?

Answer 5

2 weeks.

Question 5

What are the post surgical precautions in blowout orbital fractures?

Answer 5

Contact sports and nose blowing should be avoided for up to 6 weeks after surgery

Question 6

What is Hyphaema ?

Answer 6

It is the haemorrhage into the anterior chamber of the eye.

Question 7

What are the causes of hyphaema?

Answer 7

– Trauma
– After eye surgery
– Neovascularization
– Ocular neoplasms
– Uveitis
– Vascular anomalie

Question 8

What are the physical examination findings in hyphaema?

Answer 8

– Evidence of trauma
– Blood settling in lower part of anterior chamber
– Slit lamp for evidence of trauma
– Assess VA for pre-treatment baseline

Question 9

What are the special tests in Hyphaema ?

Answer 9

– IOP must be measured as sometimes the collecting
blood can inhibit normal aqueous drainage

Question 10

What is the management of hyphaema ?

Answer 10

• treat the underlying cause.
• Patch and shield
• Monitor IOP
• Cycloplegic eyedrop and paracetamole for pain.
  Avoid NSAIDs and aspirin due to anti-platelet effects.
• Sleep with HOB 30-35 degrees
• It resolves in less than one week.

Question 11

What is retinal detachment ?

Answer 11

It is the separation of inner layers of retina from underlying retinal pigment epithelium. Hole or tear in nerve layer of retina allows fluid to accumulate between retina and choroid.

Question 12

What is the presentation of retinal detachment ?

Answer 12

The patients complaint of
– Sudden onset of flashing lights
– Shower of floaters
– Vision loss
– Curtain-like shadow in peripheral field that expands towards central vision.

Question 13

What are the PE findings in retinal detachment ?

Answer 13

• VA is usually unchanged unless macula is involved.
• Shafer’s Sign
  *Fundoscopic exam
• Best if indirect fundoscopic exam performed for full evaluation of retina.
• Detached segment will usually be obvious with indirect but may be hidden from view with direct fundoscopy.

Question 14

What is Schaffer’s sign?

Answer 14

Clumping of pigmented cells in anterior chamber
and on corneal endothelium also known as “tobacco dust.

Question 15

What is the management of retinal detachment ?

Answer 15

It is an opthalmologic emergency and the patient’s head should be turned towards affected eyes.
– Surgical options
* Pneumatic retinopexy
* Scleral buckling
* Vitrectomy

Question 16

What is amaurosis fugax ?

Answer 16

Transient loss of vision in one eye most commonly and both eyes rarely with complete resolution. The patient complaint of currtain comes down over visual field. The causes can be TIA or CVA and the management depends on the cause.