Trauma to the Globe and Orbit

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Trauma to the eye represents approximately 3% of all emergency department visits in the United States. Rapid assessment and examination following trauma to the eye is crucial. A thorough knowledge of potential injuries is imperative to ensure rapid diagnosis, to prevent further damage to the eye, and to preserve visual capacity. This article describes the aspects of the eye examination that merit special attention in the case of trauma. It then discusses the eye injuries most likely to be seen in the emergency department and their appropriate treatment.

Section snippets

History and physical examination

The general principles of the routine ocular examination also pertain to an examination in the setting of trauma, but certain aspects of the examination deserve special attention. Triage and registration personnel should be instructed regarding the urgency of eye injuries and of the need for simultaneous treatment and triage. One always should “take a step back” when considering eye injuries and assess the entire patient. Life- or limb-threatening injury should be addressed initially. In

Plain films

Plain film radiographs of the orbits and sinuses are rarely used for diagnosis in orbital trauma. When performed, various views can provide information regarding the orbits and sinuses, such as the presence of an orbital wall or facial bone fracture or opacification of the sinuses. The conventional Caldwell's and Waters' views have moderate sensitivity in detecting orbital fractures: 73% to 78% for fractures of the orbital floor, 71% for fractures of the medial orbital wall, and 64% for

Contusion

Periorbital contusion and swelling may be the most prominent initial features in patients presenting to the hospital following trauma to the orbit. The appearance of the ecchymosis and swelling can be dramatic and make examination of the orbit challenging (Fig. 2). The emergency physician always must attempt to examine the structures underlying the swollen eyelids. Examination of the underlying tissue may be aided with a Desmarres retractor, which will help avoid global pressure and damage to

Conjunctival lacerations

Lacerations of the bulbar conjunctiva are commonly associated with intraocular foreign bodies or underlying sclera perforation, so a ruptured globe must be ruled out. Conjunctival lacerations may be seen as a conjunctival defect, exposure of Tenon's capsule, or orbital fat. Slit-lamp examination can help differentiate superficial from deep lacerations. Small, superficial lacerations (< 1 cm) require no suturing and generally heal rapidly. Lacerations that are greater than 1 cm may be repaired

Acknowledgment

The authors thank Dr. John Lee for his expert manuscript review and comments.

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