Kassam Karim, Rahim Ishrat, Mills Caroline
Department of Oral & Maxillofacial Surgery, Northwick Park Hospital, London HA1 3UJ, UK.
Case Rep Emerg Med. 2013;2013:376564. doi: 10.1155/2013/376564. Epub 2013 Nov 18.
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.
小儿眼眶骨折应始终给在急诊科工作的所有临床医生敲响警钟。诊断和适当转诊的延迟或失败可能导致迅速发展且严重的并发症。我们报告一名儿童在自行车事故中眼部受伤。接收转诊时未发现眼部体征；然而，在我们科室检查时，该患儿视力下降、无瞳孔反应且存在眼肌麻痹。CT扫描显示有骨块压迫眼球，患儿被紧急送往手术室取出骨碎片。术后未见改善，诊断为外伤性视神经病变。本文简要讨论了使小儿眼眶损伤复杂化的因素、其相关的“危险信号”以及适当的转诊问题。
