Optimizing visual outcomes in patients sustaining traumatic ocular injuries requires prompt diagnosis and treatment. Immediate and appropriate intervention in vision-threatening emergencies has the capacity to reduce long-term loss of visual acuity and dramatically affect post-injury quality of life.
Mechanisms of eye injury are changing, with recent data reporting a significant incidence of ocular trauma from motor vehicle accidents (MVAs), specifically, from air-bag deployment, assaults, falls, and from sports-related activities. The majority of these injuries are sustained by young men.
In the ER, order CT scan of the orbits with fine cuts (1-2mm) and true coronals, this is particularly important for IOFB.
Eye traumas can be divided into three groups: globe injuries, periorbital injuries, and chemical injuries.
The evaluation of blunt and penetrating injuries to
the orbit represents a challenge to the practicing
This article describes the pertinent information that should be gathered during a focused ocular history in a patient with ocular injury, and also provides a systematic approach to evaluating ocular trauma.
While our minds seem to go first to orbital fractures in patients with blunt ocular trauma, our primary considerations should be the truly vision threatening emergency diagnoses:
Retrobulbar hematoma with orbital compartment syndrome,
Retinal detachment and
This episode of CRACKCast covers Rosen’s Chapter 71, Ophthalmology. Part B of this episode covers ocular trauma, including indications for ophthalmology consult and surgical repair.
Teardrop pupil: Open globe injury (treat with antibiotics, eye protection, ophthalmology consultation, tetanus vaccine, treat pain and nausea).
Blunt ocular trauma presents a number of pathological entities that can have a profound and permanent effect on the patient's vision. Appropriate, logical, and systematic examination with proper first aid and timely consultation can reduce morbidity and provide for optimum recovery and outcomes.
We delve into core content on eye trauma using Rosen’s (8th edition) Chapter 71 and Chapter 241 in Tintinalli (8th edition).
“Less than Lethal” impacts can still lead to significant morbidity.
Eye injuries can be severe and quite painful. They are even worse when you can not get medical attention due to being in a remote area of the world and may even prove life threatening in such an situation
This patient has Iridodialysis: localized separation or tearing away from the iris from the ciliary body.
Physical exam is key!!!
Several differential diagnoses to consider:
Globe Rupture (Open Globe),
The spectrum of ocular trauma ranges from simple corneal abrasions to orbital fracture and ruptured globe. As might be expected, even injuries that are classified as "minor" can cause considerable morbidity to the patient.