ORBITAL TRAUMA

Princesa Sofia 09-80Novina Firlia 09-83Deski Shindy C.P Made 09-85

Anatomy

Outline

1. Assessment of Trauma2. Types of injury

Peri-ocularAnterior segmentPosterior segment

3. Chemical injury

Epidemiology● 40% of monocular blindness is related to trauma The leading cause of monocular blindness● 70-80% injured are male● Age range is 0-100 yrs but most are young average age 30yr

(American academy of opthalmology april 2011)

Sources of Injury Blunt objects - 30-40%

rocks, fists, branches, champagne corks Motor Vehicle Injuries - 9% Play or sports - 1/3

golf/squash balls, shoulder/elbow, bats/racquets, horse

Falls - 4% Sharp objects – 18%

(American academy of opthalmology april 2011)

Definition

Eye trauma refers to damage caused by a direct blow to the eye that the trauma may affect not only the eye but the surrounding, including adjacent tissue and bones structure.(Bausch+Lomb)

Symptoms of Eye trauma

• Bruising• Cuts to the eyelid• Eye redness• Swelling• Bleeding between the cornea and iris, known as

hyphema• Retinal detachment• Blurred or cloudy vision• Double vision

Chemical Burn

Thermal Burn

Examples: Curling Iron Burn. UV Irradiation. Sun Viewing. X-ray Radiation.

Orbital Fracture/Periorbital Contusion Hematoma

Fracture fragments and herniation of periorbital tissues into the maxillary sinus

Pathogenesis of orbital floor blow-out fracture

Assessment History

Detailed as possible Time and nature of injury

Missile, blunt, chemical etc

Past ocular history Previous VA and lid function remember trauma is a recurrent pathology

Med Hx tetanus, Anticoagulation

Examination Tissue loss Layers of lid Lid Margin Canaliculi Prolapsed fat/septal involvement Levator function Lagophthalmos Canthal tendon/angle

Image

CT - fine cuts orbits If unable to determine posterior aspect of

wound If suspect orbital fracture/ other injuries

Repair

TimingIdeally within 12-24 hours of injuryCan delay up to 1 week

Patient factorsGross swelling

– Ice packs to reduce– Steroid

AnaesthesiaGA / LA

Repair: General Principles

Clean woundMinimal debridementCareful handling of tissuesCareful alignment of anatomy

Lid margins, lash line, skin folds etcClose in layers