#EMconf: Ocular Trauma Pearls
Thu, 04/27/2017 - 6:23am
Quick Guide to Ocular Trauma:
- Globe rupture suspected on exam? STOP! Put nothing in the eye (even fluorescein if possible), place a shield over the eye. Call OPTHO stat!
- Acid / base splashes? Irrigate copiously with water until pH normalizes (~7.2). If damage noted or vision changes, call ophtho.
- Foreign objects or debris under the eyelid? Remove with a cotton swab. How to evert eyelids: https://www.youtube.com/watch?v=AceOwfpPWNw
- Triad of proptosis, decreased extraocular movement and visual loss? Think retrobulbar hematoma. Consider lateral canthotomy. True eye emergency!
- Check for afferent pupillary deficit, visual field deficits and changes in visual acuity. If any of these are present in the setting of trauma, strongly consider optho evlauation for a more detailed ocular exam
- Check extra ocular movements. Unable to look superiorly, consider Inferior rectus entrapment from orbital floor fracture
- Hyphema present? Grade 3 or higher: call optho otherwise, timolol eye drops. Complications include rebleeding and glaucoma (especially in Sickle Cell patients) so remember to check IOP!
- Complicated lid laceration: affecting medial half of eye lids, fat prolapse, full thickness wound? Call ophtho
- Corneal abrasions? Don’t forget the antibiotics! If they are contact lens wearers use quinolone based antibiotic