Eye trauma March 2018 | by EMauthor Blunt trauma •Examine eye as soon as you can before swelling of eye lids prevent it. If the swelling is already advanced consider ophthalmology referral •Always assess visual acuity. Any impairment in vision requires urgent referral •Assess ocular movement, especially in vertical plane, any restriction suggests blow out fracture •Subconjunctival haemorrhage on its own does not require treatment •Soft eye ball suggest rupture of the globe, don’t apply any pressure on the eye •Examine the cornea and sclera for lacerations •Examine the anterior chamber for hyphaema, blood in the anterior chamber: refer •Irregularity of pupil may indicate tear in the iris, discuss with ophthalmologist •Dislocation of the lens or traumatic cataract, refer •Fundoscopy should be done in all cases, assess for vitreous haemorrhage or retinal detachment Penetrating trauma •Usually evident, but can be small and subtle •Examine the eye gently and without pressure, use amethocaine if necessary •Once diagnosed apply an eye shield, not a pad, don’t apply any topical medication and refer immediately to ophthalmologist. Give the required analgesia. Lacerations around the eye •Try to obtain the best cosmetic results •Eyebrow lacerations, obtain perfect hairline alignment •Lid lacerations require expert repair, especially if through tarsal plate. Discuss with senior and/or refer |
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