Does the eye have a hyphema? Of course, we also want to examine the retina to make sure there's no obvious retinal tear or detachment. Are there any associated injuries such as orbital fractures or lacerations that need attention? Does the patient require antibiotics? This may be the case if there's an orbital fracture. "If the globe is closed, we follow an algorithm of checking to see what the injuries are. "Closed-globe injuries usually involve blunt force to the face or eye," Dr. Management is entirely different depending on whether or not the globe is ruptured. Such signs would include the IOP in the traumatized eye being significantly lower than the fellow eye if the pupil is a different size from the other eye or is misshapen in some way, suggesting that the iris may be plugging a peripheral wound if the anterior chamber is shallower or deeper than the fellow eye and if there is significant chemosis-usually 360 degrees and usually hemorrhagic-suggesting that there may be bleeding through a scleral rupture." "However, a rupture in the globe can also be fairly subtle, so you need to check for other clinical signs that suggest that the eye is open. "Sometimes a ruptured globe is fairly obvious because the globe is misshapen or contents are extruding," notes Dr.
Pupil misshapen full#
On the other hand, if the patient has a corneal laceration and you're not sure whether a foreign object entered the eye, or the eye is full of blood obscuring your view, you'll need to do a CT scan." If you can see through the cornea and there's nothing in the anterior chamber and you can do a complete examination of the angle, iris, lens, vitreous and the posterior segment with the slit lamp and an indirect ophthalmoscope, you can be pretty sure there's no occult damage. "One key issue is whether there are intraocular injuries. "It's important to do a complete eight-point ophthalmic evaluation," he continues. "How deep does the injury go? What structures are involved? What tools will you need to accomplish the repair? Bowes Hamill, MD, associate professor of ophthalmology at Baylor College of Medicine in Houston, says when faced with a seriously traumatized anterior segment, he looks for answers to several key questions. "Whether the patient has light perception or no light perception is very important with respect to prognosis, especially if the globe turns out to be open," he notes. Recchia says this should be the first order of business in the examination.
The surgeons list a number of key steps to take during your examination: Was it a high-velocity injury? Is there a possibility of penetration with a retained foreign body? Was there assault? Were drugs involved? In the case of a motor vehicle collision, what were the details? Once you've made a global or systemic assessment and taken a history of the circumstances surrounding the injury, your examination should begin." "Then, a history is helpful both for clinical management and for documentation in case of legal action down the road. "You want to make sure the patient doesn't have any other occult injuries that could be more life-threatening than the ocular injury," he explains. He notes that the first two actions to take when encountering a patient who has undergone ocular trauma are to make sure the patient is systemically stable and to get a history of the incident. Recchia, MD, associate professor of ophthalmology and visual sciences and chief of the Retina Division at the Vanderbilt Eye Institute in Nashville, Tenn., has contributed to several books dealing with the management of ocular trauma. (Of course, every injury is unique, so any step-by-step guidelines must be adapted to the situation at hand.)įranco M. When a patient who has suffered ocular trauma is first seen, the initial objective must be to determine the nature and extent of the injury.
Here, three surgeons with extensive experience discuss their approaches to managing these kinds of trauma. In general, the more serious types of ocular trauma-such as ruptured globes and corneal lacerations requiring surgical reconstruction-are less frequently seen by most ophthalmologists. (According to the United States Eye Injury Registry, 95 percent of ocular trauma injuries occur in males, most of whom are under 30 years of age sadly, most of these injuries are preventable.) An estimated 2.4 million eye injuries annually result in more than a billion dollars a year in total costs to society.
Ocular trauma, although not an everyday encounter for many ophthalmologists, is a serious problem for our health system and economy.
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