POTD: Trauma Tuesday - Eye trauma review

Dr. Marshall's only request for POTD is that we touch on a trauma topic on the most alliterate day of the week related to trauma.  That being.... trauma Tuesday.  So here goes....

This guy comes in.  


Physical exam is key!!!

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Use your tool.   Use POCUS if eye is swollen shut.  Tegaderm first, lots of U/S jelly.  Is there a pupillary response to light?  Is there a consensual response?  Is the anterior chamber present?  Is the posterior chamber normal appearing (black/round/smooth throughout)?  Is there retinal detachment or vitreous hemorrhage?  What is the overall shape of the globe? (guitar pick = bad = suspicious for retrobulbar hematoma).  

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 Normal Eye U/S:


Retrobulbar Hematoma on U/S ( measure that pressure and think about clipping that lateral canthus):

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Traumatic ocular injuries seen in ED:

Globe rupture


Retrobulbar Hematoma

Lens dislocation

retinal detachment

corneal abrasion/ulceration

Lid Lacerations

Globe Rupture:  Prevent increased IOP (elevate HOB, avoid eye manipulation), Seidel test, cover with eye shield, pain meds, topical and systemic antibiotics and Optho consult.  

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Hyphema: Blood in anterior chamber, Elevate HOB, consult optho, patients at highest risk:  sicklers, trauma, bleeding diathesis, the anticoagulated

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Retrobulbar Hematoma:  Usually 2/2 trauma, can cause optic nerve and retinal ischemia leading to permanent blindness if untreated, A lateral canthotomy is indicated if: proptosis, decreased visual acuity or pain on EOM, afferent pupillary defect or IOP > 40 mmHG

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Lens dislocation (aka ectopic lensis): typically 2/2 blunt trauma (less common mechanisms are electrocutions/lightning strike or in Marfan's patients.  Painful, + or - lens tremor on exam.  Emergent optho consult if elevated IOP.

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Retinal Detachment:  patient says they see "floaters, black dots and flashes of light." Typically acute painless vision loss.  Seen as undulated highly reflective membrane (wavy white line) on U/S.  Consult optho.

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Corneal Abrasion/Ulceration:  fluorescein and woods lamp.  Flip eyelid -  multiple linear abrasions often imply retained foreign body under eyelid.  Antibiotics and analgesia.  

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Can anyone guess what caused this corneal abrasion?!?!?

(an airbag impact on car accident)

Lid Lacerations:  What can we(as ED providers) safely repair in the ED?