Test 1: Ocular Trauma Flashcards
(109 cards)
history taking
ocular trauma dictates a careful history to assess potential damage history taking typically more difficult in an injured patient children must be carefully questioned and compare the reported events to the type of injury being presented
FB history
origin material possible angle of trajectory risk of microbiologic contamination
chemical injury history
detailed history performed after irrigation begun determine agents involved how long was agent exposed to eye before treatment was any treatment begun amount of agent involved may be result from a variety of circumstances ie. explosion, trauma
blunt trauma history
determine amount of energy transferred to globe and orbit physical characteristics of the object location of impact area associated head and back injuries
animal bite history
type of animal circumstances surrounding injury animal’s location
thermal burn history
temp of agent duration of contact if electrical, determine energy, entrance and exit points
eyewall
cornea and sclera technically the eye wall has 3 coats posterior to the limbus clinically only a violation of the most external structure is taken into consideration
closed globe injury
no full thickness wound of eye wall
open globe injury
full thickness wound of eye wall
contusion
no full thickness wound of eye wall injury due to either direct injury by the object (choroidal rupture) or the changes in shape of the globe (angle recession)
lamellar laceration
partial thickness wound of eye wall
rupture
full thickness wound of eye wall caused by blunt object wound caused by an inside out mechanism because the incompressible vitreous/aqueous allows the force of the increased IOP to be transmitted to the weakest point of the eye (site of impact, old wound, etc.)
laceration
full thickness wound of eye wall caused by sharp object wound occurs at the impact site by an outside to inside mechanism
penetrating injury - entrance wound
if more than one wound present, each must be caused by a different agent
penetrating injury - retained foreign object
technically a penetrating injury, but grouped separately because of different clinical implications
perforating injury
entrance and exit wounds both wound caused by the same object
VA
establish baseline initially pinhole if correction not available use any reading material if no standard print available if NLP is determined, use the brightest light source available
EOM
rule out ruptured globe defects should be carefully recorded ID of paretic or underacting muscles
pupils
indicate intracranial pathology blunt trauma pupillary reaction shows a characteristic response: initially, spastic miosis is seen later traumatic mydriasis inspected for shape, location, light reaction dilated pupil with head injury may indicate increasing intracranial pressure presence of APD
visual fields
confrontation tangent screen amsler grid
orbital trauma - orbital assessment
globe displacement: symmetry of globe position, relative axial position orbital rim palpation: integrity of orbit, localized at bony suture lines, superior rim fracture, medial rim fracture infraorbital nerve sensation orbital emphysema: palpable air in the periorbital tissues motility: restricted movement, forced duction testing
orbital blow out fracture symptoms
diplopia pain eyelid swelling after blowing nose
orbital blow out fracture signs
ecchymosis ptosis nosebleed
orbital blow out fracture examination
complete examination ipsilateral cheek sensation lid palpation anterior chamber for: iritis, hyphema, choroidal and/or retinal damage, increased IOP forced duction testing after 1-2 weeks CT or plain films if surgical repair or confirmation of diagnosis
