OCULAR  TRAUMA  

 

Common test:

  1. X-rays: can visualize orbits, FB, sinuses. Water's view useful to evaluate orbital floor and AF level in maxillary sinuses.  Caldwell's view evaluates medial and superior aspect of orbit as well as ethmoid and frontal sinuses.
     
  2. CT 1.5mm is method of choice to evaluate in details orbits, sinuses and determine exact location of FB optic nerve, ocular muscles and intraocular structures.
     
  3. US should be performed by ophthalmologist and is useful to evaluate for retinal detachment, vitreous hemorrhage, etc.

 

Orbital Fx :

 

  1. Can involve any  wall, but most often orbital floor and lamina papiracia . As a consequence orbital contents may prolapse  into the sinus. This can lead to entrapment of intraorbital content, ocular muscle, nerve and even  the globe itself.  Findings can range from minimal to diplopia in primary gaze, chemosis, decrease or loss sensation in the distribution of maxillary nerve. Nose blowing and Valsalva maneuver are to be avoided.
     
  2. X-ray (false negatives are possible) and CT (test of choice) are tools for diagnosis. These can show AF level and/or herniated contents.
     
  3. Immediate ophthalmology consult is required if  there is enophthalmos, diplopia in primary gaze or suspicion for ruptured globe.  Consult is also mandated if herniation  of contents is identified by CT.
     
  4. If only AF  is present pt can be DC home with ice packs, Td, antbx to cover Staph / Strep, avoidance of Valsalva and nose blowing.

 

Ruptured Globe :

 

  1. Occurs secondary to severe blunt or sharp trauma. Pt may present with  flat anterior chamber, chemosis, ( visual acuity, hyphema, vitreous heme, retinal detachment). Pt is given antbx, eye shield, pain meds and STAT ophthalmology consult.

 

Vitreous Hemorrhage:

 

  1. May be secondary to vascular disease ( like diabetes), trauma or vitreous contraction (retinal tear or retinal detachment).

 

Retroorbital Hematoma:

 

  1. Due to trauma, orbital plexus bleeds and creates pressure  on globe that could damage optic nerve and expose anterior segment of the eye.
     
  2. Pt presents with pain , diplopia, proptosis, ( visual acuity and ocular movement, possible afferent pupillary defect)
     
  3. STAT ophthalmology consult, ice, head elevation and CT are required.

 

Subconjunctival Hemorrhage:

 

  1. may be just local damage of capillaries or sign of ruptured globe.

 

Hyphema:

 

  1. Blood in anterior chamber  secondary to trauma.
     
  2. Volume can vary from  simple blood dot to full anterior chamber.
     
  3. Most common symptom is decrease or loss of vision, but may be almost assymptomatic.
     
  4. STAT ophthalmology consult  is mandatory,  as this may lead to significant elevation of IOP (especially important in patients with sickle cell anemia -  never give Diamox to these patients- this may induce sickling crisis). 

 

Iritis - see above

 

Intraocular FB - see above

 

Traumatic Mydriasis/Miosis

  1. Both mydriasis and miosis can  be secondary to functional (contusion, inflammation) or structural (rupture of the sphincter) cause. They usually resolve in few days.

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