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