Ocular Trauma Flashcards
red eye presentations should be categorised into
traumatic and non-traumatic
this can be illicit from the history
management of chemical injury
topical anaesthetic, lid eversion and sweep, irrigation,
oral analgesia, pH strips
urgent ophthalmology referral: topical ABs, cycloplegics, artificial tears, steroids, topical ascorbic acid, oral doxycycline and vitamin C, surgery
orbital floor fracture
may trap the inferior rectus
causes an eye to fail to look up
Hx of orbital fracture
acute trauma, pain and blurring
vertical diplopia
nosebleed
protective eyewear
examination of orbital fracture
peri-orbital ecchymosis, diplopia on upgaze,
bradycardia
normal IOP
mild dilated pupil (traumatic mydriasis)
traumatic midriasis
when the pupil is dilated following trauma
management of isolated orbital floor injury
nasal decongestants
avoid nose blowing
rest
analgesia
ice packs
broad spectrum antibiotics to prevent orbital infection due to direct access to the sinuses
retrobulbar haemorrhage history
severe acute trauma
rapid loss of vision
anticoagulants
aetiology of retrobulbar haemorrhage
orbital compartment syndrome
examination of retrobulbar haemorrhage
proptosis, peri-orbital ecchymoses, subconjunctival haemoglobin, retracted EOM
raised or unrecognisable IOP, RAPD, hyphaema
management of retrobulbar haemorrhage
urgent lateral canthotomy/cantholysis
urgent CT orbitus/brain
urgent referral to ophthalmology
broad spectrum antibiotics, analgesia, IV acetazolamide +/- hydrocortisone
penetrating eye injury
acute trauma, pain, loss of vision
tear drop pupil
tissue prolapsing through the eye
penetrating eye injury on examination
shallow anterior chamber
sidle sign +ve, when you put fleeuroscene on the eye fluid will be seen leaking out of the site of penetration
uveal prolapse (the iris tissue may plug to would and prevent it from being siedel positive)
management of penetrating eye injury
use a shield not a pad
urgent ophthalmology referral
fast for theatre, CT orbits/brain
tetanus injection, IVABs
why can’t you ultrasound the eye in a penetrating eye injury
because an US involves pressure on the eye
