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A 7 year old boy is brought to the emergency department by his teacher following an injury to the left eye that morning.

Describe and interpret the photo and outline your management.

ANSWER

The obvious findings on the photograph are a hyphaema of approx 30%. There is also a partial ptosis of the lid and infra-orbital abrasions.

We need to get a full history of how the injury occurred i.e.., what is the exact mechanism? We need to exclude other injuries. Traumatic hyphaemas are usually the result of projectiles, however the abrasion may not fit in with this story. This is a grade 2 hyphaema ie., 1/3-1/2.

The history should include:

-past history

-medications as well as

-immunisation status, as this is a potentially tetanus prone wound.

Examination should include:

-visual acuity as well as

-CN III, IV, VI, including

-afferent pupillary defect and

-slit lamp examination.

-Tonometry will also be needed as raised intra-occular pressure occurs in about 1/3 of cases, but beware of missing the globe rupture and if this is suspected, tonometry should not be performed.

Management is a shield over the eye, rest, analgesia and sitting at a 30-45 degree angle to hasten clearing of the eye and improvement of visual acuity.

Admission is indicated in this patient firstly because of the size of haematoma(certainly if there is any sickle cell trait) and secondly because there may be no-one available at home,which may be evidenced by the parents/carers not being present. The question needs to be raised as to why the parents are not present as the implication in the question, is that this injury occurred earlier in the day.

 

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