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Operational Medicine 2001
Emergency War Surgery
Second United States Revision of The Emergency War Surgery NATO Handbook
United States Department of Defense

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Emergency War Surgery NATO Handbook: Part IV: Regional Wounds and Injuries: Chapter XXIV: Wounds and Injuries of the Eye

Management: Major Injuries: Orbit

United States Department of Defense


Orbit. A careful examination of the globe is mandatory in all cases of injury to the orbit. The globe is significantly injured in 25% of orbital fractures. Retrobulbar hemorrhage must be detected and treated if it is producing marked elevation of intraocular pressure and/or decreased visual acuity. If so, a lateral canthotomy and cantholysis of the inferior crus of the lateral canthal tendon should be performed. If these maneuvers do not produce an improvement in intraocular pressure (i.e., decreasing it) and vision, the hemorrhage must be released by an incision through the conjunctiva and Tenon's capsule between the lateral rectus and the inferior rectus muscle into the muscle cone. The incision should be made with sharp scissors, and blunt tip scissors should be used to gently spread the orbital fat within the muscle cone to permit the escape of blood. Pressure on the globe and optic nerve during any surgery upon the orbit and its contents must be avoided. Blindness can result from prolonged retraction pressure on the globe and nerve. Intraorbital extraocular foreign bodies are best left undisturbed unless they are large (greater than 1 cm in largest diameter) or are producing globe or optic nerve dysfunction. Radiographic evaluation of orbital fractures should include a stereo Waters' view and computerized tomography with coronal and sagittal reformatting. The latter is especially important in the evaluation of fractures of the optic canal. Blowout fractures of the orbital floor in general do not require immediate repair. Forced duction testing should always be performed before resorting to surgical repair. If surgery is performed, ductions of the globe should be tested intraoperatively to help prevent incarceration. of tissues incident to surgical manipulation.  

 

 


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Operational Medicine 2001

Health Care in Military Settings

Bureau of Medicine and Surgery
Department of the Navy
2300 E Street NW
Washington, D.C
20372-5300

Operational Medicine
 Health Care in Military Settings
CAPT Michael John Hughey, MC, USNR
NAVMED P-5139
  January 1, 2001

United States Special Operations Command
7701 Tampa Point Blvd.
MacDill AFB, Florida
33621-5323

This web version is provided by The Brookside Associates Medical Education Division.  It contains original contents from the official US Navy NAVMED P-5139, but has been reformatted for web access and includes advertising and links that were not present in the original version. This web version has not been approved by the Department of the Navy or the Department of Defense. The presence of any advertising on these pages does not constitute an endorsement of that product or service by either the US Department of Defense or the Brookside Associates. The Brookside Associates is a private organization, not affiliated with the United States Department of Defense.

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