What kind of orbital wall fracture needs to be repaired?
Orbital fractures are repaired if there is muscle trap, enophthalmos, or displacement of the globe.
OphthoBook-Question – Trauma
How do you evaluate a patient with suspected open-globe?
Attempt to get vision, but don’t press on the eye. CT scan. The eye is usually explored and repaired under anesthesia.
Which type of sickle cell patient has more eye problems: type SC or SS?
Type SC seems to have more eye problems (ischemia and bleeding in the retina) than SS (which has more systemic painful crises).
What medication should you avoid in a sickle-cell patient with a hyphema?
Avoid carbonic anhydrase inhibitors, both topical drops and diamox, as this medication acidifies the aqueous fluid and promotes sickling in the AC.
Why do we dilate eyes with internal inflammation?
Dilation paralyzes the iris and this helps with pain control. Dilation also helps break synechia (adhesions) of the iris.
What is traumatic iritis, and how do you treat it?
Traumatic iritis is internal ocular inflammation after blunt injury. It causes pain, photophobia, and redness. Treatment is usually dilation and steroids.
How might an inflammed conjunctiva be a good prognostic sign in cases of chemical eye injury?
An inflamed, red conjunctiva is good as this means that the chemical didn’t “burn away” the conjunctival and episcleral vessels.
What chemical is worse to get in the eye, an acid or base?
Base chemicals (high pH) are worse for the eye. Acids tend to coagulate tissue and limit spread.. Bases tend to denature proteins and penetrate deeper and deeper.
How are chemical injuries to the eye treated?
Irrigation, irrigation, irrigation. The quicker you can irrigate the offending agent, the better the visual prognosis.
How are metal foreign bodies removed from the cornea?
Usually start with a q-tip. Then most people progress to blunt needle or forceps. Residual rust rings are polished off with a spinning Alger brush.
What might make you suspicious for a foreign body inside the eye?
History of high-speed metal (grinding, hammering), decreased pressure, flat anterior chamber. If in doubt get a CT scan.
What is the surgical approach when sewing up lid-margin lacerations?
You need to line up the lid margin first with a big stitch. Then approximate the posterior and anterior layers of the lid with sutures.
What’s the most problematic location for a lid laceration?
Lid lacerations that occur medially (near the nose) are problematic as it may cut through the canaliculus.
What exam findings should you document with an orbital wall fracture?
Orbital rim fractures, enophthalmos, diplopia, and sensation along the V2 distribution.
Which orbital bone is most likely to fracture with blunt orbital trauma?
The orbital floor, the maxillary bone, is the most common orbital fracture.
How do you diagnose a corneal perforation?
A perforation can be diagnosed by using the Seidel test to see if any aqueous fluid is leaking out.
How do you diagnose a corneal abrasion?
Abrasions are easiest seen by bathing the eye with yellow fluorescein dye, and viewing the cornea using a blue light.
What is a layer of blood inside the anterior chamber called?
Blood in the anterior chamber is called a hyphema.