see also: [[Facial trauma radiology]], [[Lateral canthotomy]] see: [Rosen Eye trauma](x-devonthink-item://43FF5B61-AC39-42AF-AADD-6BB6C2B8800B?page=0), [Dunn - Ocular trauma](x-devonthink-item://CBA7F4ED-132F-416E-B9C2-EF6568768AD6), [Tintinalli - blunt eye trauma](x-devonthink-item://FD6F18CE-FB87-49A1-B46B-6EA51187ED3B?page=24&start=5135&length=17&search=%0ABLUNT%20EYE%20TRAUMA) # corneal foreign body ## rust ring - large rust rings may require removal over a few days - sometimes easier to remove after 24 hours; otherwise refer - use motorised dental burr; needle tip removal often causes more extensive corneal injury - topical abx drops QID # traumatic iritis Anterior uveitis = iritis - occurs days after blunt trauma - symptoms are photophobia and deep eye pain - cells and flare in anterior chamber on slit lamp - Tx: discuss with ophthalmology, likely steroids and cycloplegics # orbital blowout fracture - orbital walls composed of thin bones -- orbital floor is weakest - trauma causes ==intraoccular pressure to increase== - medial orbital wall is part of the epthmoid sinus, can also have fractures - *upward gaze inhibited if rectus muscle entrapment* - pain - sometimes diplopia - numbness of cheek or upper lip if *infraorbital nerve* involvement Tx: refer to ophthal for possible delayed surgery, decongestants ![[Pasted image 20240328183222.png|upward gaze inhibition]] # retrobulbar haematoma see [Eye and ear hospital retrobulbar haemorrhage](x-devonthink-item://2796A435-F1DE-4F2E-B19B-6216D4BD63B4) ![[Pasted image 20240328180037.png]] ![[Pasted image 20240328183551.png]] - exophthalmos associated with trauma - pressure from behind globe raises IOP (>40) - retinal artery has impaired perfusion → ischaemia of eye (**orbital compartment syndrome**) - vision loss, proptosis, dilated, non-reactive pupil - needs [[Lateral canthotomy]] +/- medications to lower IOP **Medications** - acetazolamide IV/po 250-500 mg. 250 Q4H max 1g od to reduce IOP - mannitol 1-2g/kg IV over 30-60 min to reduce volume of vitreous (caution in renal and heart disease or severe dehydration) - methylpred 1gIV → neuroprotection against ischaemia, reduce spasm and oedema of microcirculation and reduce intra-orbital pressure **other measures** - position in head up position - monitor visual acuity, IOP, and RAPD # hyphema not to be confused with [[Eye infections#hypopyon]] ![[Pasted image 20240724165635.png]] - trauma causing blood in the anterior chamber of the eye - Can be a sign of [[#Globe rupture]] - can result in increased intraocular pressure, staining of eye - can be spontaneous if anticoagulated - sometimes in [[Sickle Cell Anaemia]] patients; would be more of an emergency consult in these cases - complications: - re-bleeding (second bleed usually worse) - increased risk for [[Glaucoma]] - adhesions - vision loss - Treatment: - generally outpatient - ophthal referral - bed rest - analgesia - cycloplegics - if it's an "8 ball hyphema" needs surgery Grade I - level sits below pupil Gr II - partially covers pupil Gr III - covers pupil Gr IV - fills anterior chamber completely # Chemical injury to eye > alkali injury worse than acid injury **alkali** - liquefactive necrosis **acid** - coagulative necrosis Tx: check pH, immediate irrigation, irrigate until pH is 7.4 # Globe rupture see [eye and ear ruptured globe and penetrating eye injury](x-devonthink-item://AD4352DD-5BD0-436B-B20B-CF822659B987) - do not use tonopen (no contact with eye) - do not place ultrasound on eye or any other pressure! - teardrop pupil points to rupture site - fluroscein "seidel's sign" (but don't put fluroscein in if you see globe rupture) - [[Relative afferent pupillary defect|RAPD]] > **Tx**: hard shield on eye, analgesia IV, antiemetic avoid vomit, tetanus vax, IV abx (cipro 750mg po), lie pt flat, ophthal consult . needs CT. surgical delay is a risk factor for [[Eye infections#endophthalmitis]] ![[Pasted image 20240328185235.png| teardrop pupil pointing to the site of the (obvious) globe rupture]] ![[Pasted image 20240724170545.png]] - extensive subconjunctival haemorrhage, distorted pupil / iris, hyphaema, extrusion of ocular contents ## Ocular globe rupture - results from severe ==blunt trauma== - globe decompresses at its weakest point - insertion sites of extraocular muscles - may be occult - visual acuity may be normal - *examination* - dark uveal tissue exposed at limbus - distorted pupil - decreased visual acuity - subconjunctival haemorrhage with swelling or chemosis - if suspected, manage as penetrating eye injury # Blunt trauma can lead to ocular globe rupture > note, blunt trauma is **different from orbital compartment syndrome**, which is a [[#retrobulbar haematoma]] ~ 10% of all [[Retinal detachment]] due to blunt trauma can injury anterior chamber, cause lens dislocation, significant injury manage as for occular globe rupture above ![[Pasted image 20240821123240.png]] example from practice test sowing decreased right globe volume/size, irregular right globe shap, lens posterior subluxed, moderate peri-orbital swelling