If a patient presents with both ocular and systemic trauma, diagnosis and treatment of any life-threatening injury take precedence over evaluation and management of the ophthalmic injury. Once the patient is medically stable, the ophthalmologist should elicit a complete preoperative history. The diagnosis of a traumatic ocular injury may be obvious from casual examination of the eye. However, a thorough history of the nature of the injury should always be obtained and should include questions about the history and details of the injury, such as whether the injury was associated with
Evaluation of a patient with a traumatic ocular injury should include a complete general and ophthalmic examination. As soon as possible, the examiner should determine and record visual acuity, which is the most reliable predictor of final visual outcome in traumatized eyes. Pupillary examination should be performed to detect the presence of an afferent pupillary defect (including a reverse Marcus Gunn response) arising from the possibility of traumatic mydriasis. The examiner should then look for key signs that are suggestive or diagnostic of a penetrating or perforating ocular injury (Table 14-5).
Table 14-5 Signs of Penetrating or Perforating Ocular Trauma
Table 14-6 Ancillary Tests in the Evaluation of Penetrating Ocular Trauma
If a significant perforating injury is suspected, forced duction testing, gonioscopy, tonometry, and scleral depression should be avoided. Ancillary tests that may be useful in this setting are summarized in Table 14-6. All cases should be managed with safeguards appropriate for patients known to have blood-borne infections.
Excerpted from BCSC 2020-2021 series: Section 10 - Glaucoma. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.