Blunt Eye Injury

Key history
Key examination
Initial management

Key history

• Mechanism of injury
• Systemic injury/loss of consciousness (treat as per appropriate protocol)
• Presence/extent of:
• Pain
• Vision loss
• Diplopia

Key examination

Orbit

DO Visual acuity in both eyes 

LOOK FOR

• Extent of oedema/haematoma
  • Can eye open unassisted
  • Can it be opened with gentle lid retraction
• Proptosis or enophthalmos
• Palpate integrity of orbital rim
• Sensation around the orbital especially in region of infra-orbital nerve (below eye and along the anterior superior gum)
• Eye movements

Eyeball

DO Visual acuity in both eyes

LOOK FOR

• Extent of sub conjunctival haemorrhage
• Presence of hyphaema – partial or total in anterior chamber
• Dilated non reactive pupil
• Dislocation of the lens
• Vitreous haemorrhage

Initial management

• If pain severe and peri orbital haematoma and proptosis (>5mm)
  • Perform lateral cantholysis after discussion with eye registrar if possible
  • Pain relief and antiemetics as necessary
  • CT scan orbits and brain
• If fracture present:
  • Give oral antibiotics (Augmentin or if penicillin sensitive, Erythromycin)
  • Instruct not to blow nose
  • Contact maxillofacial or plastic surgeon
• If VA is normal, globe appears normal and orbital rim and sensation intact:
  • Discharge to return if increased pain or decreased vision.
• If VA, globe or sensation impaired:
  • Discuss with on call registration (can usually wait until morning unless in severe pain)

NOTE: 

Beware of limitation of up-gaze in children that may indicate fracture of orbit floor with entrapment of muscle requiring urgent repair.

People with sickle cell disease are at greater risk of complications from hyphaema.