Blunt Trauma

Question 1

Aetiology

Answer 1

Blow to the eye and/or periorbital tissue
Can be accidental - RTA, domestic, work-place related
Non-accidental - assault

Question 2

Predisposing factors

Answer 2

Males
Falls in older people

Question 3

Symptoms

Answer 3

Mild to severe pain
Photophobia
Watering
Loss of vision
Diplopia

Question 4

Signs

Answer 4

Mild cases (VA normal)
- Conjunctiva / Lids - swelling, bruising, chemosis, SCH.
- Cornea / AC - corneal abrasion, mild hyphaema, mild AC reaction

Severe cases (VA reduced)
- Orbit / Motility
diplopia/restriction from swelling of EOM.
enophthalmos (sunken eye, fracture), proptosis (retrobulbar haemorrhage)
white eyed blow out fracture - can be seen in children without external signs

• Anterior segment
  Lens - subluxated, cataract, Vossius ring (ring of pigment on anterior lens from pupil margin),
  Cornea - oedema and laceration
  AC - hyphaema, uveitis
  Iris - traumatic mydriasis, RAPD, iridodialysis, angle recession
  IOP - increased in TBM obstruction, decreased in scleral rupture

↑ Glaucoma risk with trabecular pigmentation, hyphaema, lens displacement, or angle recession

Posterior segment: macular hole, retinal tear/detachment, vitreous haemorrhage, commotion retinae, optic nerve avulsion

NAsal bleeding may indicate skull fracture

Question 5

Non-pharmacological management

Answer 5

Take a careful detailed history to find out time of injury and mechanism

Cold compresses for lid oedema
Dilated fundus examination

Question 6

Pharmacological management

Answer 6

Systemic analgesia e.g. aspirin, paracetamol
Systemic NSAID e.g, ibuprofen for tissue swelling
Topical antibiotic for corneal abrasion
Cycloplegia for ciliary spasm pain relief
Topical steroid for traumatic inflammation e.g. Prednislone (do not give if abrasion present)

Question 7

Refer?

Answer 7

Mild cases - not needed
Severe cases - first aid measures and same day referral to hospital

Question 8

What can they do at hospital?

Answer 8

Admission
Investigation and assessment using scans e.g. ultrasound, MRI, CT, X ray
Surgical management of globe rupture.