From the Guidelines
For a contusion in the right parietal region with blurred vision, immediate medical evaluation is essential to rule out serious complications such as orbital injury or traumatic optic neuropathy, and noncontrast thin-section orbital CT imaging with multiplanar reconstructions should be considered as the initial imaging modality 1. The patient's symptoms of blurred vision and contusion in the right parietal region require a comprehensive assessment to determine the underlying cause of the visual defect. Key considerations in the evaluation of traumatic visual defects include:
- Orbital injury, which may be isolated to the orbit or have intracranial manifestations
- Traumatic optic neuropathy, which can result in post-traumatic visual loss
- The presence of peri-orbital soft-tissue swelling, hyphema, vision loss, or extraocular restriction, which can indicate orbital injury The initial imaging modality of choice for evaluating traumatic optic neuropathy and post-traumatic visual loss is noncontrast thin-section orbital CT imaging with multiplanar reconstructions, as it is superior in identifying the integrity of the osseous orbit and skull base, and useful in identifying fractures and displaced fracture trauma 1. In addition to imaging, a detailed history and examination are crucial in determining the cause of diplopia after orbital trauma, which may be multifactorial, including direct damage to the extraocular muscles and surrounding orbital structures or contemporaneous trauma to the central nervous system 1. The treatment plan should prioritize the patient's safety and visionoming, and may involve rest, pain management, and close monitoring for worsening symptoms, as well as possible surgical intervention to repair any damage to the extraocular muscles or surrounding orbital structures 1. Some key points to consider in the management of strabismus after orbital trauma include:
- Counseling the patient on the diagnosis and treatment options
- Providing goal-directed management of strabismus, including reconstructive restoration of binocular vision, or treatment of diplopia or compensatory head posture
- Informing the patient's other health care providers of the diagnosis and treatment plan
- Considering the possibility of iatrogenic strabismus after sinus surgery or other periocular surgeries, including surgery to the eyelids 1.
From the Research
Treatment for Contusion of the Perital Region with Blurred Vision
- The treatment for contusion of the perital region with blurred vision depends on the severity of the injury and the presence of any underlying conditions 2, 3, 4.
- A detailed history and complete ocular examination are crucial in assessing the extent of the injury and determining the appropriate treatment 2.
- Patients with ocular trauma, including contusion of the perital region, should be evaluated for signs of more serious injuries, such as orbital fractures, superficial corneal foreign bodies, and suspected open globe injury 2, 4.
- The management of periorbital soft tissue trauma involves assessing for damage to the lacrimal drainage system and developing a framework for approaching the patient to assess for injury and triage necessary treatments 4, 5.
- In cases where the contusion is associated with a concussion or mild traumatic brain injury, the management should follow the guidelines for concussion and mild traumatic brain injury, including prevention of chronicity and initiation of priority interventions in primary care 6.
Key Considerations
- Accurate history-taking and astute observation are paramount for timely treatment or referral that may prevent blindness 2.
- Periorbital ecchymosis is a useful clinical sign that should alert the clinician to assess for skull fractures, intracranial hemorrhage, and cranial nerve injury 3.
- Restoration of normal anatomic relationships of the eyelids and periocular structures is essential for optimum functional and aesthetic outcome after trauma 5.