From the Guidelines
Management of a left temple stab wound with orbital swelling requires immediate medical attention, prioritizing stabilization, control of bleeding, and assessment for potential complications such as globe injury or intracranial extension, as outlined in the most recent guidelines 1. The initial steps involve assessing airway, breathing, and circulation, followed by control of bleeding with direct pressure using sterile gauze. It is crucial not to remove any impaled objects as this could worsen bleeding. Tetanus prophylaxis should be administered if the patient's immunization status is unclear or outdated (Tetanus toxoid 0.5 mL IM) 1. For pain management, acetaminophen 1000 mg or ibuprofen 400-600 mg orally can be given. Antibiotic prophylaxis is essential to prevent infection; options include amoxicillin-clavulanate 875/125 mg twice daily for 7 days or, if penicillin-allergic, clindamycin 300-450 mg four times daily for 7 days 1. The orbital swelling necessitates careful evaluation for potential eye injury, vascular damage, or foreign body presence. Urgent ophthalmology and possibly neurosurgery consultation is necessary to assess for globe injury, retrobulbar hematoma, or intracranial extension.
- Key considerations include:
- CT imaging of the orbit and brain to evaluate the extent of injury and identify any foreign bodies, as recommended by recent studies 1.
- Application of cold compresses to the orbital area for 20 minutes every 1-2 hours to reduce swelling.
- Keeping the patient's head elevated to minimize edema. This comprehensive approach addresses immediate concerns while preventing complications like infection, vision loss, or neurological damage that can result from penetrating injuries near the orbit, aligning with the principles of minimizing morbidity, mortality, and improving quality of life 1.
From the Research
Management of Stab Wound to the Left Temple with Associated Orbital Swelling
- The management of a stab wound to the left temple with associated orbital swelling requires careful consideration of the potential complications, including orbital compartment syndrome, intracranial extension, and damage to the orbital structures 2.
- Imaging studies, such as computed tomography (CT) and magnetic resonance imaging (MRI), play a crucial role in evaluating the extent of the injury and guiding management decisions 3.
- CT scans can detect foreign bodies, lens dislocation, ruptured globe, choroidal or retinal detachments, and cavernous sinus thrombosis, while MRI is useful for assessing soft tissue damage and detecting organic foreign bodies 3.
- In cases of orbital floor fractures, delayed immediate surgery for up to two weeks may be considered to allow for resolution of swelling-induced diplopia, and to avoid unnecessary surgical risks and inconveniences 4.
- However, in cases of orbital compartment syndrome, immediate surgical decompression is required to prevent permanent vision impairment 5.
- The use of anticoagulative medication should be considered as a predisposing factor for orbital compartment syndrome in patients with periorbital trauma 5.
- Surgical management of temple-related problems, such as temple hollowness and masticatory oscillopsia, may be necessary in some cases, and can involve repair of the lateral wall defect, orbital decompression, and autologous fat transfer or synthetic filler 6.