Emergency management of blunt trauma to the eye

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Description: Diagnosis and treatment of patients presenting with suspected blunt trauma

Publet Introduction:

Instruction in the management of ocular trauma usually emphasizes dramatic injuries such as penetration of the eye wall, retention of foreign bodies, and associated adnexal consequences. Nonpenetrating injuries, however, are far more common and can be disastrous to visual function. These blunt injuries may challenge the diagnostic acumen of the clinician and pose vexing therapeutic questions. In addition, the eye may display significant consequences in the fundus of injuries that are completely remote from the globe. The oph-thalmologist treating   casualties will benefit from a review of posterior segment manifestationsof such injuries, including injury mechanisms, damage to the various tissue layers, and the sequelae of remote injury.


  Information
Guideline objectives

Case 

Patient is a 36-year-old male who, while working on a construction site, was struck against the right eye by a piece of ejected reinforcement steel. He was wearing protective goggles at the time. Patient was brought to the ED via EMS complaining of right eye pain and loss of vision. Upon initial examination he was noted to have folding of the superior-lateral aspect of the iris, miosis and loss of visual acuity in the right eye. He was able to detect light sensation and had positive consensual accommodation. Seidel sign was negative as was fluorescein staining.

Question

Patient arrives to your ED following blunt force trauma to the right eye with pain and decreased vision. Examination reveals moderate periorbital swelling, conjunctival hemorrhage and pupil as seen in the image above. Visual acuity is 20/30 in the left eye and light perception only in the right eye. Which of the following is the most appropriate management?

  1. Ocular ultrasound and emergency ophthalmology consultation

  2. Measure intraocular pressure and emergent ophthalmology consultation

  3. Timolol drops, intravenous acetazolamide and emergent ophthalmology consultation

  4. Eye shield, CT scan of the orbit and emergent ophthalmology consultation

Acknowledgement Medscape

 

Target setting Emergency department, Ophthalmology department
Target users Professional clinicians
Overview
Provenance The College of Optometrists (UK)
Management
  • Author: Gopikrishnan Chandrasekharan
  • Release date: 11-05-2015 22:15:00
  • Status: Draft - Under Review
  • History: First version - for demonstration only
Safety case None available
Sources

The College of Optometrists, Clinical Management Guidelines, Trauma (Blunt). Guideline PDF at http://www.college-optometrists.org/en/utilities/document-summary.cfm/docid/11A1C5A4-AEB6-433B-9C5EA2449BFE3FDE 

References