OPHTHALMOLOGY
EYE TRAUMA
PromptExamination in eye trauma (Compiled from all answers)
ResponseVisual Acuity - ? injury to visual axis - lens/retina
Pupillary Light reflex/RAPD
Globe pressure - Risk of acute angle closure glaucoma (avoid testing if globe rupture apparently as can raise IOP)
Slit lamp examination of anterior chamber - ? traumatic hyphema
Fluorescein - assess for corneal abrasion
Extraocular movements - ? Blowout fracture with entrapment
Proptosis -?retrobulbar haematoma
Fundoscopy - retinal haemorrhage/traumatic detachment
Sensation inferior orbital nerve (br. Of trigeminal N. Sensation cheek/upper lip/lateral nose) - damaged in orbital floor #’s
Read the stem. Assess for other injuries (Septal haematoma, C spine #, GCS/ICH etc.)
Pupillary Light reflex/RAPD
Globe pressure - Risk of acute angle closure glaucoma (avoid testing if globe rupture apparently as can raise IOP)
Slit lamp examination of anterior chamber - ? traumatic hyphema
Fluorescein - assess for corneal abrasion
Extraocular movements - ? Blowout fracture with entrapment
Proptosis -?retrobulbar haematoma
Fundoscopy - retinal haemorrhage/traumatic detachment
Sensation inferior orbital nerve (br. Of trigeminal N. Sensation cheek/upper lip/lateral nose) - damaged in orbital floor #’s
Read the stem. Assess for other injuries (Septal haematoma, C spine #, GCS/ICH etc.)
PromptSigns of orbital compartment syndrome
ResponseProptosis
RAPD
Restricted extraocular movement/diplopia
“Rock hard eyeball” palpated with lid closed
Pressure >35-40 mm.Hg
Visual acuity - significantly decreased >> drops to light perception only
Inability to open eye
Severe pain
Fundoscopy - Papilloedema from compressive optic neuropathy may be present. Retinal artery or venous occlusion.
(CT: proptosis, retrobulbar haematoma)
Dilated pupil in absence of central cause and CT suggesting retrobulbar haematoma
RAPD
Restricted extraocular movement/diplopia
“Rock hard eyeball” palpated with lid closed
Pressure >35-40 mm.Hg
Visual acuity - significantly decreased >> drops to light perception only
Inability to open eye
Severe pain
Fundoscopy - Papilloedema from compressive optic neuropathy may be present. Retinal artery or venous occlusion.
(CT: proptosis, retrobulbar haematoma)
Dilated pupil in absence of central cause and CT suggesting retrobulbar haematoma
PromptCauses of orbital compartment syndrome
ResponseRetrobulbar haemorrhage
Spontaneous - anticoagulant use/bleeding disorders
Extravasation of dyes/contrast/fluid (burns)
Orbital malignancy
- Trauma
- Vascular malformation/tumour
- Orbital surgery
Spontaneous - anticoagulant use/bleeding disorders
Extravasation of dyes/contrast/fluid (burns)
Orbital malignancy
PromptRetinal Detachment - Clinical presentation
ResponseVA markedly decreased
Absent red reflex
Visual field loss
Fundoscopy indeterminate/elevated retina
Painless
Absent red reflex
Visual field loss
Fundoscopy indeterminate/elevated retina
Painless
PromptLens subluxation and dislocation
ResponseBlurred vision
Quivering of the iris when the patient moves their eyes
Quivering of the iris when the patient moves their eyes
PromptRetrobulbar haematoma
ResponseProptosis
Ischaemia of the optic nerved - fixed dilated pupil
Nerve palsy/muscle entrapment - ophthalmoplegia
Ischaemia of the optic nerved - fixed dilated pupil
Nerve palsy/muscle entrapment - ophthalmoplegia