OCULAR TRAUMA . . . CONT.

BLOW OUT FRACTURES (see Plastic Surgery Chapter)

blunt trauma causing fracture of orbital floor and orbital contents to herniate into maxillary sinus

orbital rim remains intact

inferior rectus and/or inferior oblique muscles may be incarcerated at fracture site

infraorbital nerve may be damaged

Symptoms and Signs

pain and nausea at time of injury

diplopia, restriction of upgaze

infraorbital and upper lip paresthesia (CN V2)

enophthalmos, periorbital ecchymoses

Diagnosis

plain films: Waters view and lateral

CT: anteroposterior and coronal view of orbits

Management

refrain from coughing, blowing nose

systemic antibiotics may be indicated

surgery if fracture > 50% orbital floor, diplopia not improving, or enophthalmos > 2 mm

may delay surgery if the diplopia improves

SYMPATHETIC OPHTHALMIA

severe bilateral granulomatous uveitis

occurs after ocular trauma (usually penetrating and involving uveal tissue) or eye surgery, 10 days to years later

possibly due to a hypersensitivity reaction to uveal pigment

the injured eye becomes inflamed first and the other eye (sympathizing) second

Symptoms and Signs

photophobia

blurred vision

red eye

Management

if vision not salvageable in affected eye, enucleate to prevent sympathizing reaction

if inflammation in sympathizing eye is advanced, treat with local steroids and atropine ––> cyclosporin

OCULAR EMERGENCIES

these require urgent consultation to an ophthalmologist for management

trauma, especially intraocular foreign bodies, lacerations

corneal ulcer

gonococcal conjunctivitis

orbital cellulitis

chemical burns

acute iritis

acute angle closure glaucoma

central retinal artery occlusion (CRAO)

retinal detachment

endophthalmitis

giant cell arteritis