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CME

Approach to Eye Trauma - Emergency Management

General Information

General InformationGeneral Information

Background

  • Eye trauma occurs from blunt and/or penetrating forces, resulting in injuries ranging from simple abrasions to devastating globe ruptures
  • The primary goal of evaluation and management is to prevent vision loss

Anatomy

  • The orbit, made up of the frontal, lacrimal, ethmoid, zygomatic, maxilla, and palatine bones, may be fractured, especially medially or inferiorly
  • Extraocular muscles (superior, inferior, lateral and medial rectus, superior and inferior oblique) can become entrapped or injured
  • The globe is made up of 3 layers: sclera and cornea, uvea, and retina
    • Vulnerable to penetrating injury, laceration, rupture, luxation, or layer detachment (for example, retinal detachment)
  • Anterior chamber and posterior chamber which are divided by the lens
  • Optic nerve - may be injured from primary or secondary injury
  • Ophthalmic artery
  • Lateral canthal tendon—the inferior arm of this tendon is cut in a lateral canthotomy and cantholysis to reduce intraocular pressure and is a potentially vision-saving procedure which can be performed by emergency physicians in cases of blunt ocular trauma

Epidemiology

  • Traumatic ocular injuries account for 3% of emergency department visits in United States1,2
  • In 1 study, 16% of all major trauma patients, and 55% of those with facial injuries had ocular or orbital injuries3
  • Traffic accidents, sports-related injuries, and falls are common causes3,4,5,6
  • Visual deterioration or blindness from orbital trauma is uncommon (2%-5%) but clinically relevant, causing approximately 40% of monocular blindness4,5

References

References

General references used

  1. Romaniuk VM. Ocular trauma and other catastrophes. Emerg Med Clin North Am. 2013 May;31(2):399-411
  2. Bord SP, Linden J. Trauma to the globe and orbit. Emerg Med Clin North Am. 2008 Feb;26(1):97-123, vi-vii
  3. Poon A, McCluskey PJ, Hill DA. Eye injuries in patients with major trauma. J Trauma. 1999 Mar;46(3):494-9
  4. Rosado P, de Vicente JC. Retrospective analysis of 314 orbital fractures. Oral Surg Oral Med Oral Pathol Oral Radiol. 2012 Feb;113(2):168-71
  5. Colletti G, Valassina D, Rabbiosi D, et al. Traumatic and iatrogenic retrobulbar hemorrhage: an 8-patient series. J Oral Maxillofac Surg. 2012 Aug;70(8):e464-8
  6. Brandt MT, Haug RH. Traumatic hyphema: a comprehensive review. J Oral Maxillofac Surg. 2001 Dec;59(12):1462-70
  7. Kim BB, Qaqish C, Frangos J, Caccamese JF Jr. Oculocardiac reflex induced by an orbital floor fracture: report of a case and review of the literature. J Oral Maxillofac Surg. 2012 Nov;70(11):2614-9
  8. Yalcin Tok O, Tok L, Eraslan E, Ozkaya D, Ornek F, Bardak Y. Prognostic factors influencing final visual acuity in open globe injuries. J Trauma. 2011 Dec;71(6):1794-800
  9. Burm JS, Chung CH, Oh SJ. Pure orbital blowout fracture: new concepts and importance of medial orbital blowout fracture. Plast Reconstr Surg. 1999 Jun;103(7):1839-49
  10. Hwang K, Huan F, Hwang PJ. Diplopia and enophthalmos in blowout fractures. J Craniofac Surg. 2012 Jul;23(4):1077-82
  11. Caranci F, Cicala D, Cappabianca S, Briganti F, Brunese L, Fonio P. Orbital fractures: role of imaging. Semin Ultrasound CT MR. 2012 Oct;33(5):385-91
  12. McClenaghan FC, Ezra DG, Holmes SB. Mechanisms and management of vision loss following orbital and facial trauma. Curr Opin Ophthalmol. 2011 Sep;22(5):426-31
  13. Vassallo S, Hartstein M, Howard D, Stetz J. Traumatic retrobulbar hemorrhage: emergent decompression by lateral canthotomy and cantholysis. J Emerg Med. 2002 Apr;22(3):251-6
  14. Yadav K, Cowan E, Haukoos JS, et al. Derivation of a clinical risk score for traumatic orbital fracture. J Trauma Acute Care Surg. 2012 Nov;73(5):1313-8
  15. Ballard SR, Enzenauer RW, O'Donnell T, Fleming JC, Risk G, Waite AN. Emergency lateral canthotomy and cantholysis: a simple procedure to preserve vision from sight threatening orbital hemorrhage. J Spec Oper Med. 2009 Summer;9(3):26-32PDF
  16. He Y, Zhang Y, An JG. Correlation of types of orbital fracture and occurrence of enophthalmos. J Craniofac Surg. 2012 Jul;23(4):1050-3
  17. Popat H, Doyle PT, Davies SJ. Blindness following retrobulbar haemorrhage--it can be prevented. Br J Oral Maxillofac Surg. 2007 Mar;45(2):163-4
  18. Kubal WS. Imaging of orbital trauma. Radiographics. 2008 Oct;28(6):1729-39full-text
  19. Pinto A, Brunese L, Daniele S, et al. Role of computed tomography in the assessment of intraorbital foreign bodies. Semin Ultrasound CT MR. 2012 Oct;33(5):392-5
  20. Kim DJ, Francispragasam M, Docherty G, et al. Test Characteristics of Point of Care Ultrasound for the Diagnosis of Retinal Detachment in the Emergency Department. Acad Emerg Med. 2018 May 18 early online
  21. Theoret J, Sanz GE, Matero D, et al. The "guitar pick" sign: a novel sign of retrobulbar hemorrhage. CJEM. 2011 May;13(3):162-4
  22. Fraser S. Corneal abrasion. Clin Ophthalmol. 2010 May 6;4:387-90

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How to cite

National Library of Medicine, or "Vancouver style" (International Committee of Medical Journal Editors):

  • DynaMed [Internet]. Ipswich (MA): EBSCO Information Services. 1995 - . Record No. T905749, Approach to Eye Trauma - Emergency Management; [updated 2018 Nov 30, cited place cited date here]. Available from https://www.dynamed.com/topics/dmp~AN~T905749. Registration and login required.

Published by EBSCO Information Services. Copyright © 2020, EBSCO Information Services. All rights reserved. No part of this may be reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system, without permission.

EBSCO Information Services accepts no liability for advice or information given herein or errors/omissions in the text. It is merely intended as a general informational overview of the subject for the healthcare professional.

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