Diferencia entre revisiones de «Orbital fracture»

Revisión del 23:40 2 abr 2011

Initial Assessment

Eye

Acuity, extraocular movements
Blurry, double, or decreased vision?
Pain with EOM?

Pupil

Reactivity, size, shape

Globe

Proptosis or enophthalmos?
Increased intercanthal distance?
Extrusion of intraocular contents?

Orbit

Crepitus from fracture into sinuses?

DDX

Orbital Hematoma
- Proptosis, diffuse pain
Ruptured Globe
- Tear-shaped pupil
- Extrusion of intraocular content
Orbital zygomatic fracture
- Most common
Nasoethmoid fracture
- Inspect for:
  - Damage to medial canthal ligament
  - Damage to lacrimal duct
  - Medial rectus entrapment
Orbial Floor fracture
- Inspect for:

Entrapment of inferior rectus
Enophthalmos
Damage to infraorbital nerve

Retinal Detachment
Hyphema
Optic Nerve Shealth Hematoma

Treatment

Orbital CT indicated for:

Evidence of fracture on exam
Decreased extraocular mobility
Decreased visual acuity
Severe pain
Unable to perform adequate exam

Globe Injury

Eye covering
Elevate head of bed
Prevent nausea/vomiting

Orbital Hematoma

Consider lateral canthotomy

Orbital fracture into sinus

Azithromycin or augmentin

Extraocular muscle entrapment

May result in oculocardiac reflex -> vagal symptoms
- Consider release of entrapped muscle

Decreased extraocular movement not due to entrapment
- Consider corticosteroids

Orbital blowout fx

Water's view is 83% sensitive at detecting these. If present needs CT to eval soft tissue structures (retrobulbar hemmorhage). Surgical indications include greater tha 2mm enopthalmos and/or persistent diploplia.

10-20% have ocular injury. binocular diploplia from direct muscle injury resolves in 82%, but diploplia from entrapment requires surgical repair.Malignant emphysema and/or retrobulbar hemmorhage are emergencies requiring a lateral canthotomy.

@@ Línea 1: / Línea 1: @@
 ==Initial Assessment==
-# Eye
+*Eye
-## Acuity, extraocular movements
+#Acuity, extraocular movements
-## Blurry, double, or decreased vision?
+#Blurry, double, or decreased vision?
-## Pain with EOM?
+#Pain with EOM?
-# Pupil
+*Pupil
-## Reactivity, size, shape
+# Reactivity, size, shape
-# Globe
+*Globe
-## Proptosis or enophthalmos?
+# Proptosis or enophthalmos?
-## Increased intercanthal distance?
+# Increased intercanthal distance?
-## Extrusion of intraocular contents?
+# Extrusion of intraocular contents?
-# Orbit
+*Orbit
-## Crepitus from fracture into sinuses?
+# Crepitus from fracture into sinuses?
 ==DDX==
-# Orbital Hematoma
+*Orbital Hematoma
-## Proptosis, diffuse pain
+**Proptosis, diffuse pain
-# Ruptured Globe
+*Ruptured Globe
-## Tear-shaped pupil
+**Tear-shaped pupil
-## Extrusion of intraocular content
+**Extrusion of intraocular content
-# Orbital zygomatic fracture
+*Orbital zygomatic fracture
-## Most common
+**Most common
-# Nasoethmoid fracture
+*Nasoethmoid fracture
-## Inspect for:
+**Inspect for:
-### Damage to medial canthal ligament
+***Damage to medial canthal ligament
-### Damage to lacrimal duct
+***Damage to lacrimal duct
-### Medial rectus entrapment
+***Medial rectus entrapment
-# Orbial Floor fracture
+*Orbial Floor fracture
-## Inspect for:
+**Inspect for:
-### Entrapment of inferior rectus
+#Entrapment of inferior rectus
-### Enophthalmos
+#Enophthalmos
-### Damage to infraorbital nerve
+#Damage to infraorbital nerve
-# Retinal Detachment
+*Retinal Detachment
-* Hyphema
+*Hyphema
-* Optic Nerve Shealth Hematoma
+*Optic Nerve Shealth Hematoma
 ==Treatment==
-===Orbital CT indicated for===
+*Orbital CT indicated for:
-# Evidence of fracture on exam
+#Evidence of fracture on exam
-# Decreased extraocular mobility
+#Decreased extraocular mobility
-# Decreased visual acuity
+#Decreased visual acuity
-# Severe pain
+#Severe pain
-# Unable to perform adequate exam
+#Unable to perform adequate exam
 ===Globe Injury===
@@ Línea 48: / Línea 48: @@
 *Prevent nausea/vomiting
-Orbital Hematoma
+===Orbital Hematoma===
 * Consider lateral canthotomy
-Orbital fracture into sinus
+===Orbital fracture into sinus===
-* Azithromycin or augmentin
+*Azithromycin or augmentin
-Extraocular muscle entrapment
+===Extraocular muscle entrapment===
-* May result in oculocardiac reflex -> vagal symptoms* Consider release of entrapped muscle
+*May result in oculocardiac reflex -> vagal symptoms
+**Consider release of entrapped muscle
-Decreased extraocular movement not due to entrapment
+*Decreased extraocular movement not due to entrapment
-* Consider corticosteroids
+**Consider corticosteroids
-Orbital blowout fractures-Water's view is 83% sensitive at detecting these. If present needs CT to eval soft tissue structures (retrobulbar hemmorhage). Surgical indications include greater tha 2mm enopthalmos and/or persistent diploplia.
+===Orbital blowout fx===
+*Water's view is 83% sensitive at detecting these. If present needs CT to eval soft tissue structures (retrobulbar hemmorhage). Surgical indications include greater tha 2mm enopthalmos and/or persistent diploplia.
 -20% have ocular injury. binocular diploplia from direct muscle injury resolves in 82%, but diploplia from entrapment requires surgical repair.Malignant emphysema and/or retrobulbar hemmorhage are emergencies requiring a lateral canthotomy.