PANCE Blueprint EENT (7%)

• Pain with EOM, epistaxis, erythema/ecchymosis, “raccoon eyes”
• Anesthesia/paresthesia in the gums, upper lips, and cheek indicate damage to the infraorbital nerve

TX: Prompt ophthalmic referral ⇒ treatment with surgery

• Antibiotics to prevent infection

• fluorescein dye demonstrates increased absorption in the devoid area

TX: Antibiotic eye ointment, no patching

• Any full-thickness injury to the cornea, sclera, or both is considered an open globe injury
• The vitreous and/or aqueous humour drain through the site of the rupture causing the eye to deflate (sunken appearance)
• Immediate ophthalmology consultation
• CT scan: non-contrast 1 to 2 mm cuts axial and coronal through the orbits

TX: Avoid any examination procedure that might apply pressure to the eyeball, such as eyelid retraction or intraocular pressure measurement by tonometry

• Requires referral to ER or emergent ophthalmologist
• Do not remove any protruding foreign bodies
• Begin IV antibiotics with Vancomycin PLUS either ceftazidime or fluoroquinolone
• Avoid placing any medication (eg, tetracaine) or diagnostic eye drops (eg, fluorescein) into the eye
• A Fox eye shield or other rigid devices (bottom of a polystyrene foam cup) should be placed over the affected eye
• Surgical repair should be expedited

• The blood may cover part or all of the iris (the colored part of the eye) and the pupil, and may partly or totally block vision in that eye
• Usually from blunt/penetrating trauma ⇒ ensure no other type of injury (skull fracture, orbital fracture)

DX: orbital CT if indicated + ophthalmology consult

TX: usually, blood is reabsorbed over days/weeks

• Elevate head at night @ 30 degrees, acetaminophen for pain, patch/shield
• May use beta-adrenergic blockers or carbonic anhydrase inhibitors
• Surgery if high pressure/persistent bleeding
• NSAIDs contraindicated (may increase bleeding)