The NCCPA™ PANCE EENT Content Blueprint => disorders of the eye => traumatic disorders
| Blowout fracture (ReelDx) | ReelDx Virtual Rounds (Blowout fracture)Patient will present as → a 13-year-old who was hit in the right eye by a baseball. The area is ecchymotic and swollen. He complains of pain, rated 6 out of 10. On physical exam, the patient has eyelid swelling, decreased visual acuity, enophthalmos (sunken eye), and anesthesia/paresthesia in the gums and upper lips. History of blunt trauma, muscle entrapment, eyelid swelling, gaze restriction, double vision, decreased visual acuity, enophthalmos (sunken eye)
DX: diagnosed with CT scan TX: Prompt ophthalmic referral ⇒ treatment with surgery
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| Corneal abrasion (ReelDx) | ReelDx Virtual Rounds (Corneal abrasion)Patient will present as → a 10-year-old boy who was hit in the right eye with a piece of bark that was thrown on the playground. He developed sudden onset of eye pain, photophobia, tearing, and blurring of vision. He claims there is “something stuck in my eye.” On physical examination, there is significant conjunctival injection. Sudden onset of eye pain, photophobia, tearing, foreign body sensation, blurring of vision, and/or conjunctival injection DX: fluorescein staining - increased absorption in the devoid area TX: Antibiotic eye ointment, no patching |
| Globe Rupture | Patient will present as → a 15-year old male with no significant PMHx is brought to the emergency department by his coach after being struck in the right eye by a baseball. The patient reports pain in the right eye with complete loss of vision. On physical examination, you note scleral buckling and the visual acuity testing reveals light perception only. Globe rupture occurs when the integrity of the outer membranes of the eye is disrupted by blunt or penetrating trauma
DX: 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
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| Hyphema (ReelDx) | ReelDx Virtual Rounds (Hyphema )Patient will present as → a 14-year-old who sustained blunt trauma to his right eye after being struck by a baseball. He complains of blurry vision. On physical exam, you note unequal pupils, injected conjunctiva/sclera, and blood in the anterior chamber of the right eye. Trauma causes blood in the anterior chamber of the eye (between the cornea and the iris) and may cover the iris
DX: orbital CT if indicated + ophthalmology consult TX: usually, blood is reabsorbed over days/weeks
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