%0 Journal Article
%T Paediatric Orbital Fractures: The Importance of Regular Thorough Eye Assessment and Appropriate Referral
%A Karim Kassam
%A Ishrat Rahim
%A Caroline Mills
%J Case Reports in Emergency Medicine
%D 2013
%I Hindawi Publishing Corporation
%R 10.1155/2013/376564
%X The paediatric orbital fracture should always raise alarm bells to all clinicians working in an emergency department. A delay or failure in diagnosis and appropriate referral can result in rapidly developing and profound complications. We present a boy of childhood age who sustained trauma to his eye during a bicycle injury. Acceptance of the referral was based on no eye signs; however, on examination in our unit the eye had reduction in visual acuity, no pupillary reaction, and ophthalmoplegia. CT scan suggested bone impinging on the globe and the child was rushed to theatre for removal of the bony fragment. Postoperatively no improvement was noted and a diagnosis of traumatic optic neuropathy was made. An overview of factors complicating paediatric orbital injuries, their associated ”°red flags”±, and appropriate referral are discussed in this short paper. 1. Introduction Orbital fractures in children can present the attending clinician with a diagnostic dilemma. This stems from suboptimal patient cooperation and differing physiological response to trauma especially orbital. It is important that the clinician anticipates these differences when assessing a child and makes the correct diagnosis so as not to compromise the outcome. 2. Case Presentation A boy of childhood age was referred from an A&E department to a maxillofacial unit following a fall from a bicycle. The right side of his face had fallen into the handlebar of the bicycle before his head hit the ground. The patient was transferred to the accepting hospital some five hours after the initial incident following a period of neurological observation. The referral was accepted by the maxillofacial team on the basis of information given by the referring clinician: that the patient had been cleared of head and C-spine injury, that there were no eye signs on departure, and that a CT scan had been performed. Glasgow Coma Scale was said to be 15/15. On examination by the maxillofacial team at the accepting hospital to which he was transferred, forcefully separating the lids of the affected eye was necessary to facilitate full assessment. The affected eye had a fixed and dilated pupil, with the patient complaining he was unable to see. On review of the CT head, it was clear that a fractured bony fragment was impinging directly onto the globe (Figures 1 and 2). There had been no mention of the relation of this fragment to the globe in the CT report from the referring hospital. The patient was rushed to theatre by the maxillofacial team for removal of the bony fragment (Figure 3) and then transferred
%U http://www.hindawi.com/journals/criem/2013/376564/