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Blowout Fracture
- A fracture of the orbit
Clinical Presentation
- “I got my face smashed in!”
- Ecchymosis
- Difficulty with vertical eye movement
- Diplopia
- Infraorbital anesthesia secondary to trauma to the infraorbital nerve
- Swelling
- Subconjunctival hemorrhage
Labs, Studies and Physical Exam Findings
- X-ray – orbital floor fracture may show Teardrop sign. This is herniated orbital contents.
- Get an orbital CT
Treatment
- May be be monitored depending on the fracture
- Prophylactic antibiotics may be given
- Surgical repair may be necessary
Foreign Body
Clinical Presentation
- “I have something in my eye”
Labs, Studies and Physical Exam Findings
- Visual acuity test should be done first for a baseline
- Apply a local anesthetic. Do not give to patient for self administration.
- Fluorescein stain may be helpful
- Woods lamp may be helpful
- Slit lamp may be helpful
- If it is steel it may leave a rust ring
Treatment
- Sterile wet cotton tipped applicator or hypodermic needle should be used to remove the object
- Polymyxin-bacitracin ointment should be applied
- Eye patches lead to an increase rate of infection
- Intraophthalmic foreign body should be referred immediately to an ophthalmologist. Do not attempt to remove the object.
Corneal Abrasions
- Most likely caused by physical trauma
Clinical Presentation
- I got poked in the eye
- Patient may feel like he has a foreign body
- Severe pain
- Photophobia
Labs, Studies and Physical Exam Findings
- Evaluate for foreign body
- Fluorescein will stain an abrasion darker than the rest of the cornea
Treatment
- Most heal in a few days
- Polymyxin-bacitracin ointment
- NSAIDS
- Eye patches lead to an increase rate of infection
Hyphema
- Blood in the anterior chamber
- Most frequently traumatic. In a kid this is child abuse until proven otherwise
- Blood vessel abnormality
- Cancer in the eye
- Sickle cell Anemia
Clinical Presentation
- Blood in the anterior chamber of the eye
- Vision abnormalities
- Pain
- Photophobia
Labs, Studies and Physical Exam Findings
- Blood in the anterior chamber
- Measure IOP
Treatment
- Blood is reabsorbed in a few days
- Sleep with head of bed at a 45 degree angle
- Recommend patient not read or watch television
- Eye patch
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