Ver el código de «Orbital trauma»

==Background==
[[File:Schematic diagram of the human eye en.png|thumb|Eye anatomy.]]
*Must [[Eye exam|assess]]:
**Visual acuity
**Anterior chamber
**Integrity of globe
**Pupil shape and reactivity
*Use paperclip or eyelid speculum to open swollen eyes

==Clinical Features==
*Anterior chamber is flat +/- abnormal pupil
**[[Ruptured globe]] is certain
**Stop the exam; place eye shield, consult ophtho
*[[Hyphema]]
**Evidence of significant trauma; consult ophtho
*Extra-ocular movements
**Restricted upgaze or lateral gaze suggests [[orbital fracture]] with entrapment
***Obtain CT face
*Orbital Rim
**Feel for step-off
*Sensation
**Test along distribution of inf orbital nerve (below eye and ipsilateral side of nose)
*Photophobia
**If photophobia in affected and unaffected eye, suspect traumatic iritis
*[[vision loss|Decreased visual acuity]] +/- proptosis
**Clinically suspect [[orbital hematoma]], check [[intraocular pressure|IOP]] if open globe has been ruled out

===Exam===
[[File:Teardrop pupil.jpg|thumb]]
**Bird's eye view for exophthalmos with retrobulbar hematoma
**Worm's view for endophthalmos (blow-out fracture) or malar prominence flattening (zygoma fracture)
*[[vision loss|Acuity]]
*[[Diplopia]]
**Binocular diplopia suggests entrapment of extraocular muscles
**Monocular diplopia suggests [[lens dislocation]]
*Extraocular motion
**Limitation on upward gaze occurs with [[orbital fractures|fracture of inferior and medial orbital wall]]
*Pupil
**Teardrop sign ([[globe rupture]]), [[hyphema]], reactivity (swinging flashlight test)
*[[intraocular pressure|Pressure]] (only if rule out globe rupture)
**Check in patients with exophthalmos, afferent nerve defect or evidence of [[retrobulbar hematoma]

==Differential Diagnosis==
{{Eye trauma}}
{{Maxillofacial trauma DDX}}
{{Unilateral red eye DDX}}

==Evaluation==
*[[Slit-lamp]] exam with fluorescein
**Check for:
***[[corneal abrasion|Abrasion]]
***Laceration
***[[corneal ulcer|Ulceration]]
***[[ocular foreign body|Foreign body]]
***Hyphema
***Hypopion
***[[Iritis]]
***[[Lens dislocation]]
***[[Globe rupture]]
*Consider non-contrast face/orbital CT
*Consider [[ocular ultrasound]] (if no suspicion for globe rupture)

==Management==
*Based on specific injury

==Disposition==
*Depends on specific injury

==External Links==
*[http://webeye.ophth.uiowa.edu/eyeforum/tutorials/trauma.htm EyeRounds Ocular Trauma]
*[http://www.emdocs.net/em-cases-blunt-ocular-trauma/ emDocs Ocular Trauma]

==See Also==
*[[Maxillofacial trauma]]

==References==
<references/>

[[Category:Ophthalmology]]
[[Category:Trauma]]