Bored review: 3/3/2015 Looking Beyond the Injury

by sbogoch • March 3, 2015 • Comments Off

A 27-year-old female presents following a “fall” at home. The patient denies having LOC, has had no vomiting since the incident. She denies blurred or decreased vision in the effected eye, no neck pain, no weakness, no numbness or tingling. Exam shows a well appearing woman with vital signs that are within normal limits. The patient has periorbial ecchymosis and a swollen eyelid. The patient has full extraocular movements, 20/20 vision bilaterally, and no proptosis. There is a 25% subconjunctival hemorrhage to the lateral aspect of the the left eye. There is marked tenderness on palpation of the orbital rim. You perform a CT scan of the orbits and find that she has an orbital fracture of the left medial wall. Along with antibiotics, vasoconstricting nasal spray and follow up with ENT, what other diagnosis must we consider?

answer

This patient presents with an isolated orbital fracture following a “fall.” We must consider domestic violence for all patients and inquire about safety at home. Approximately 30% of orbital fractures in female patients are attributed to domestic violence. We must ask explicitly about domestic violence to ensure safety of our patients.

Rivers, 7th edition.

By: Andy Grock and Sally Bogoch

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