ORBITAL TRAUMA

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Anatomy

Outline
1. Assessment of Trauma 2. Types of injury
Peri-ocular Anterior segment Posterior 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
Timing
Ideally within 12-24 hours of injury Can delay up to 1 week
Patient factors Gross swelling
Ice packs to reduce Steroid

Anaesthesia
GA / LA

Repair: General Principles

Clean wound Minimal debridement Careful handling of tissues Careful alignment of anatomy
Lid margins, lash line, skin folds etc

Close in layers