Orbital Trauma

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Case Presentation 12 hrs s/p blepharoplasty – c/c: bleeding eyelid. “I’ll only see a plastic surgeon.” PE- venous blood from incision VSS, eye grossly normal VA – 20/20 bilaterally , PERL Plastics: “What kind of insurance does he have? Cash? I’ll be down.” 3- 4 hours later- repeat PE: VSS, right eye dilates to light.

Blowout Fracture- Presentation Definition Symptoms Pain Double vision Numbness to cheek tenderness Critical signs Restricted EOM Subcutaneous emphysema Globe displacement Globe trauma 32%
Blowout Fracture - Etiology Theories Waterhouse 1999 Buckling Hydraulic Fracture site Inferior wall Medial wall Superior rim CNS injury CSF leak Intracranial - bleed
Blowout Fracture- X-ray Screening Teardrop sign
Blowout fracture- Management Consults Nasal Decongestants Antibiotics Evidence? Sneezing/Blowing Nose Disposition With entrapment Without entrapment Associated injuries

Ruptured Globe – Presentation Incidence 1.1-3.5% Symptoms Predictive signs 1) VA showing light perception or worse. 2) Abnormal deep/shallow anterior chamber. 3) Opacity preventing view of fundus. 4) IOP of 5 or less.
Ruptured Globe - Management Diagnosis Suspected – STOP Examination Do NOT put pressure on globe RSI Br. J of Anesth 1999 Antibiotics Tetanus Antiemetic CT scan Prepare for surgery.

Retrobulbar Hemorrhage - Presentation Definition Symptoms Critical signs Proptosis Visual acuity Marcus-Gunn pupil Red desaturation
Management “TIME IS RETINA” Progressive Lateral canthotomy CT scan of orbit Disposition

Hyphema- Presentation Definition Symptoms Grading 0 RBC’s I <1/3 II 1/3 – 1/2 III >1/2 IV eight ball
Hyphema- Management Ophthalmic consult Pupillary play/Eye Patch Reverse Trendelenburg Anesthesia /Anti-emetic IOP control > 30 mmHg (>24 mmHg in HbSS) Admission HbSS Anti-coagulated > Grade I Decreasing VA ED evaluation >1 day after initial injury. Complications Re-bleed Post-traumatic glaucoma

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