Blunt Eye Trauma

Examining the patient with Periorbital Ecchymosis (“Black Eye”)

 

1.  Pupils

• Irregular, pear-shaped pupil = Ruptured Globe
• Non-Reactive pupil = Ruptured Globe (until proved otherwise)

2.  Visual Acuity

• Decreased acuity, doesn’t pinhole = Ruptured Globe (until proved otherwise)

3.  Inspect Sclera

• Fluid leak = Ruptured Globe
• Unilateral Exophthalmos or Lid Lag = Retro-orbital Hematoma
• Large / Bullous Subconjunctival Hemorrhage = ? Ruptured Globe

4.  Inspect Iris (pt. sitting / erect)

• Level of blood at bottom = Hyphema

5.  If all normal so far, Palpate Globe (gently wiggle eye through closed upper eyelid)

• Tenderness suggests Ruptured Globe

6.  Inquire about flashing lights, or new onset lots of floaters

• Maybe early retinal detachment

If Everything Normal Up to Here

7.  Check Extraocular Movements (EOMs)

• Deficit = entrapment (orbital fracture)
• Tenderness = risk to Globe

8.  Palpate Orbital Bones

• Focal tenderness = possible fracture

9.  Confirm History

• Unconvincing story  —   suspect Domestic Violence

IF SUSPECT RUPTURED GLOBE —  CALL 9-1-1

 

A)  Cover eye with hard shield (e.g. tape on an upside-down paper cup)

B)  Keep patient in dark room

C)  Consider sedation (parenteral or rectal)

D)  If nauseated, consider anti-emetic (parenteral or rectal)

E)  NOTHING BY MOUTH  —  strict n.p.o.  [heading to OR]

F)  Call destination ER Attending to confirm there’s Ophtho on-call