Traumatic disorders (PEARLS)
The NCCPA™ PANCE EENT Content Blueprint traumatic disorders of the eye (PEARLS)
Blowout fracture (ReelDx) |
History of blunt trauma, muscle entrapment, eyelid swelling, gaze restriction, double vision, decreased visual acuity, enophthalmos (sunken eye)
- 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
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Corneal abrasion (ReelDx) |
Sudden onset of eye pain, photophobia, tearing, foreign body sensation, blurring of vision, and/or conjunctival injection
TX: Antibiotic eye ointment, no patching |
Globe Rupture |
Globe rupture occurs when the integrity of the outer membranes of the eye is disrupted by blunt or penetrating trauma
- 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
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Hyphema (ReelDx) |
Trauma causes blood in the anterior chamber of the eye (between the cornea and the iris) and may cover iris
- 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)
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