Ophtho On Call Case 6: Physical Exam

Ophtho On Call Case 6 Index

Answer: It is best to avoid manipulating or trying to remove the foreign object out of the eye to prevent further injury or increase infection risk. For similar reasons, the eye should not be flushed and tonometry should be avoided. In addition, a rigid eye shield (Fox shield) should be used to protect the eye.

All other components of the physical exam should be done.

Physical Exam: 

General appearance: Anxious male on a stretcher
Vitals: Temp: 37C, BP: 140/80, HR: 102, RR 17, 
Best Corrected Visual Acuity (BCVA): OD Hand Motion at 1 Foot, OS 20/20
Pupils: OD mydriatic, fixed, and peaked nasally, OS round and reactive
EOM: OD -2 adduction, OS full
Intraocular pressures: Deferred

External ocular exam:
Eyelids: OD laceration involving right eyebrow, OS flat
Conjunctiva: OD 3+conjunctival injection with 360 chemosis, apparent subconjunctival uveal prolapse nasally, OS white and quiet
Cornea: Clear OU  
Anterior Chamber: OD formed, 60% hyphema, OS deep and quiet
Iris: OD peaked nasally, OS round and reactive 
Lens: OD clear but partially subluxed inferiorly, OS clear

Dilated fundus exam:
Vitreous: OD +Vitreous hemorrhage, OS clear
There is no view posteriorly in the right eye. The left dilated fundus exam is WNL.

An external image of the right eye is shown below:

globe rupture

Above Image courtesy of Kyle Hirabayashi, MD

Given these findings, what’s at the top of your differential now?
Globe rupture
Retrobulbar hematoma/orbital compartment syndrome
Orbital fracture
Orbital cellulitis
Traumatic iritis
Traumatic hyphema
Intraocular foreign body

What additional tests would you like to perform for this patient?
Orbital CT with contrast
Orbital CT without contrast
MRI orbits

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Ophtho On Call Case 6 Index
Ophtho On Call Case 6 Introduction
Ophtho On Call Case 6 Introduction