Sight-threatining injuries

Sight-threatining injuries

You respond to a bar frequented by a rowdy crowd. Upon arrival, you find a police officer outside, talking to a man leaning against a motorcycle. You learn that a fight has taken place and the person speaking with the police officer was the one who has been injured.

The patient is a 31-year old male who had been drinking beer and throwing darts when a fistfight broke out over a dart game. No weapons were used, but the fight rolled out into the street and several chairs were broken on the way out. The other fighter is handcuffed in the back of the police car, beating his head against the window; he may soon become a patient himself.

The original patient complains of a headache and blurred vision. He has some bruises on his face and what appears to be blood around the orbit of the right eye, but no other evident injuries. Although the patient denies cervical spinal pain, you place him in C-spine control because of his apparent intoxication and belligerence.

Once in the ambulance, you examine the patient’s right eye more closely. The orbital rim around the right eye is bruised. Blood is present over the sclera (the white part of the eye). Likewise, a small amount of blood appears to be in the eye’s anterior chamber. You check the visual acuity and note that the patient can only see fingers held close to the right eye.

The patient is transported to your local facility. From there, medevaced to a trauma center. A computed tomogram (CT) of the head and facial bones is negative. After clearance by the trauma team, an opthamologist evaluates the patient. It is found that the patient has a subjunctive hemorrhage and a Grade 2 hyphema of the right eye. The patient’s retina of the right eye cannot be completely evaluated, but it is believed a retinal detachment is possible. The patient is admitted to the hospital, placed in a bed with the head elevated and started on pain medication and a diuretic acetazolamide (Diamox). His hyphema slowly resolves over the course of a week. His visual acuity in the affected eye remains 20/100, and damage may be permanent.

What would your on scene care be for this patient:

 

 

 

 

 

 

 

 

 

 

 

Try to answer the following questions, research may be necessary to help you find the answers.

1. Which muscle is responsible for moving the eye clockwise?
  1. Inferior rectus
  2. Superior rectus
  3. Interior oblique
  4. Superior oblique
2. Which cranial nerves control the extrinsic muscles of the eye?
  1. Cranial nerves I, II, IV
  2. Cranial nerves II, III, VII
  3. Cranial nerves III, IV, VI
  4. Cranial nerves IV, V, VI
3. The transparent covering of the portion of the eye where the light enters is called the:
  1. Cornea
  2. Sclera
  3. Pupil
  4. Retina
4. The intrinsic eye muscles are contained in which layer of the eye?
  1. Fibrous tunic
  2. Vascular tunic
  3. Inner tunic
  4. Neutral tunic
5. What is the function of the retina?
  1. To convert light images into neural impulses
  2. To transmit the neural impulses to the brain
  3. To process the neural impulses to meaningful images
  4. To store the images for retrieval by the brain
6. Visual acuity is the ability to distinguish between:
  1. Light and dark
  2. Moving and stationary objects
  3. Various colors
  4. Forms
7. Covering the patient’s left eye and determining when they can see your finger as it moves from an outer limit toward their nose and into their view tests their:
  1. Visual acuity
  2. Peripheral vision
  3. Papillary reaction
  4. Depth perception
8. What is the normal position of the eyelid in relation to the eyeball?
  1. Eyelids should not cover any portion of the iris
  2. Eyelids should cover the iris as far as the pupil
  3. Eyelids should cover only the whites of the eye
  4. Eyelids should cover the upper quarter of the iris
9. Conjunctiva colored bright red suggests:
  1. An allergic reaction
  2. Infectious conjunctivitis
  3. Bleeding under the conjunctiva
  4. Shock
10. Anisocoria means:
  1. Unequal pupils
  2. Opaque covering of the cornea
  3. Glaucoma
  4. Constricted pupils
11. When you shine a penlight in the patient’s right eye, you expect the pupil of the left eye to:
  1. Constrict
  2. Dilate
  3. Be unaffected by the light
  4. Dilate, then constrict
12. A single pupil reacting sluggishly to light suggests:
  1. Opiate overdose
  2. Lesion of the pons
  3. Pressure on the ocularmotor nerve
  4. Brain death
13. Asking a patient to follow an object as you move it from a distance toward the bridge of the nose allows you to assess:
  1. For the presence of glaucoma
  2. Visual acuity
  3. Processing speed of the retina
  4. Accommodation
14. Nystagmus, or a fine jerking of the eyes:
  1. May be normal if noted at the far extremes of the field of vision
  2. Indicates opiate overdose
  3. Occurs when foreign bodies are present in the eyes
  4. Is common in patients with hypoxic brain injuries
15. What is the treatment for subconjunctival hemorrhage?
  1. Immediate surgery
  2. Release pressure on the affected eye
  3. Irrigation with saline or water
  4. No treatment is necessary
16. What types of injuries commonly occur due to blunt trauma to the eye?
  1. Hyphemas and retinal detachments
  2. Lid lacerations
  3. Corneal and conjunctival abrasions
  4. Enucleated eye
17. A hyphema is:
  1. An accumulation of blood in the posterior chamber of the eye
  2. Usually associated with penetrating trauma
  3. Treated by lowering the patient’s head to allow for proper perfusion
  4. A serious injury that could threaten the patient’s sight
18. Which of the following is a common sign of a blowout fracture?
  1. Inability to look upward
  2. Difficulty closing the eyelids
  3. Excessive tearing
  4. Blood accumulation in the anterior chamber of the eye
19. Patients with retinal detachments complain of:
  1. A sensation of flashing lights
  2. Extreme eye pain
  3. Excessive tearing in the affected eye
  4. Difficulty with near vision, but not with far vision.

Answers: 1. c, 2. c, 3. a, 4. b, 5. A, 6. a, 7. b, 8. d, 9. c, 10. a, 11. a, 12. c, 13. D, 14. a, 15. d, 16. b, 17. a, 18. a, 19. a