EM in 5: Ocular Trauma

Author: Anna Pickens, MD (@AnnaEMin5, Creator of EMin5) // Edited by: Alex Koyfman, MD (@EMHighAK), Brit Long, MD (@long_brit), and Manpreet Singh, MD (@MprizzleER)

Welcome to another edition of EMin5 with Dr. Anna Pickens. This week looks at 5th metatarsal fractures. Enjoy the video!

Video

Ocular Trauma Evaluation: Examination

Tools:

Open Globe = Ophthalmologic Emergency

Normal Pupil:

Pupil abnormality:

Not reactive to light: Retrobulbar hematoma (treat with lateral canthotomy and cantholysis), uncal herniation (treat elevated ICP, surgical drainage)

Teardrop pupil: Open globe injury (treat with antibiotics, eye protection, ophthalmology consultation, tetanus vaccine, treat pain and nausea)

Visual Acuity:

Extraocular Movements:

Surface:

Issues: Abrasion, Foreign Body, Conjunctival Hemorrhage, Chemosis, Hyphema

Lid Lacerations:

Seidel’s Test = If positive, think open globe!

Suggested/Further Reading:

• Articles/Posts:
  • CORE EM – Traumatic Ocular Injuries
  • LITFL Eye Trauma
  • LITFL Befuddler 013
  • LITFL Befuddler 031
  • LITFL Befuddler 033
• Podcasts: 
  • EM Cases – Ocular Trauma
  • FOAM Cast Episode 51 – Ocular Trauma