PANCE Blueprint EENT (7%)

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
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
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)
Retinopathy (Lecture) (Prev Lesson)
(Next Lesson) Blowout fracture (ReelDx)
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