Pediatric emergency medicine trisk 3679 3679

orbital roof fracture is suspected. Plain radiographs have little role in the
management of orbital wall fractures as they lack sensitivity. The necessity and
timing of surgical intervention is controversial; however, most agree that
significant extraocular restriction or persistent vomiting necessitates surgical
intervention. Orbital hemorrhage can lead to orbital compartment syndrome.
Retrobulbar hemorrhage can cause central retinal artery hypertension or even
occlusion. Vision loss, severe pain, and proptosis suggest retrobulbar hemorrhage.
A high suspicion or established diagnosis of such symptomatic hemorrhages
necessitates emergent lateral canthotomy and cantholysis by a trained emergency
provider or surgeon ( Fig. 114.8 ).

EYELID LACERATIONS
CLINICAL PEARLS AND PITFALLS
The following findings require ophthalmology consultation: fullthickness laceration of the eyelid, ptosis, orbital fat prolapse, eyelid
margin involvement, injury in close proximity to the tear duct system,
tissue avulsion, and concurrent globe injury ( Table 114.3 ).

Current Evidence
Simple eyelid lacerations may be managed by emergency providers with standard
wound care techniques; however, it is standard of care to initiate prompt
ophthalmology consultation when deeper injuries are suspected.

Goals of Treatment
Similar to other lacerations, the primary goal is wound closure to achieve
hemostasis, cosmesis, and prevent infection. Emergency providers may repair
simple lacerations of the eyelid and surrounding area using standard wound
closure methods. However, those lacerations requiring further evaluation for
possible injury to the eye itself, tear ducts, or other key structures or those
requiring surgical expertise should be promptly recognized.

Clinical Considerations

Clinical Recognition
Although eyelid lacerations are usually easy to detect, the clinician must
remember that the underlying globe might also have been lacerated or injured.
Seemingly superficial lacerations of the eyelid may be associated with penetration
into the orbit or intracranial cavity, particularly when a pointed implement caused