{"id":1227,"date":"2018-02-09T06:06:32","date_gmt":"2018-02-09T06:06:32","guid":{"rendered":"http:\/\/emultrasound.sdsc.edu\/?p=1227"},"modified":"2020-07-21T23:57:01","modified_gmt":"2020-07-21T23:57:01","slug":"ocular-us-in-trauma","status":"publish","type":"post","link":"https:\/\/emultrasound.ucsd.edu\/index.php\/2018\/02\/09\/ocular-us-in-trauma\/","title":{"rendered":"Case # 13: What Lies Beneath"},"content":{"rendered":"
\n
\n
\n

A\u00a030 year old male presents to the emergency department after blunt trauma to the face from an altercation. He notes he was punched several times in the face but did not pass out. His exam is notable for significant right periorbital ecchymosis and edema with inability to open his eye. You are\u00a0unable to perform a direct eye exam given the significant periorbital swelling.\u00a0 A CT maxillofacial\u00a0is performed which shows an isolated right inferior orbital wall fracture.<\/p>\n

Vitals: T\u00a098.6 HR\u00a085 BP 142\/81\u00a0 RR\u00a014 O2 98% on RA<\/p>\n

Prior to ENT consultation, a bedside ultrasound of the orbits is performed.\u00a0 In spite of being unable to open the eye, what can you tell your consultant regarding your exam?<\/p>\n<\/div>\n<\/div>\n<\/div>\n

\n
\n
\"ezgif.com-resize\"<\/a>

<\/p><\/div>\n<\/div>\n

\n
\"ezgif.com-resize<\/a>

<\/p><\/div>\n<\/div>\n<\/div>\n

\n
\n
\n

Answer and Learning Points<\/h3>
\n

Answer<\/strong><\/p>\n

Using ultrasound as an adjunct to your exam, you are able to tell the consultant that there is a normal appearing, reactive pupil and that the extra-ocular movements of the eye are intact. The consultant is appreciative over the phone and is happy to come in and see the patient whom after evaluation is discharged home with close outpatient follow up.<\/p>\n

Learning Points<\/strong><\/p>\n

It is often the case where a patient suffers such significant facial trauma that a complete physical exam of the orbit due to periorbital swelling is not possible. Ultrasound can be a critical tool in these cases to provide useful information to assess for multiple potential pathologies. Previous studies have shown the ability of ocular ultrasound in trauma to detect elevated intracranial pressure (via optic nerve sheath diameter), retinal detachment, vitreous hemorrhage, and retrobulbar hematoma. It can also be used for early detection of muscular entrapment in the case of an orbital wall fracture, as well as performed serially for pupillary response in patients with significant neurological injury at risk for deterioration and potential herniation.<\/p>\n