Eye Injury- Baseball

Abstract

HISTORY: A 12 year-old male sustained an injury to left eye during a baseball game. While playing first base, the outfielder threw a ball to him so patient could tag the runner out. When catching the ball, he missed, and instead the ball struck him in the face in the area of the left eye. There was no loss of consciousness, vomiting, hematoma or altered mental status. He initially had difficulty seeing out of the eye, but vision returned soon after and appeared blurry. PHYSICAL EXAMINATION: Normocephalic. With the exception of limitation in upward gaze of left eye, the remaining extraocular movements were intact. Hyphema of left eye noted. Pupils equal, round and reactive to light bilaterally. Moderate left periorbital edema and ecchymosis. Vision intact to left eye. Sensation intact in V1-V3 distribution, facial nerve function intact bilaterally. Normal occlusion, midface stable. Hearing to spoken voice intact and TM’s clear with no evidence of hemotympanum. Remainder of examination was normal. DIFFERENTIAL DIAGNOSIS: 1. Orbital Ridge Fracture 2. Orbital Blowout Fracture 3. Hyphema 4. Retinal detachment 5. Commotio Retinae 6. Globe Rupture TEST AND RESULTS: CT facial bones: -Blowout fracture of left inferior and medial wall of left orbit -Left orbital emphysema with small contusion vs hematoma within the retrobulbar fat -Minimal blood within the left ethmoid and maxillary sinus Ophthalmology Consult: -Visual Acuity 20/30 Right, 20/200 Left -3 mm Hyphema of left eye -Commotio Retinae of left macula -Normal intraocular pressure FINAL/WORKING DIAGNOSIS: Left orbital floor fracture, Traumatic Hyphema, Commotio Retinae involving the macula TREATMENT AND OUTCOMES: 1. CT scan without significant displacement and no ocular muscle entrapment on repeat exam, no operative repair needed; follow-up with plastic surgery 1-2 weeks 2.Per ophthalmology recommendations: a. Ongoing observation for cataract, retinal detachment, and glaucoma due to increased risk from blunt ocular trauma b. Bed rest with bathroom privileges 3-4 days c. Ophthalmic prednisolone and ophthalmic atropine for hyphema with monitoring for absorption and rebleed d. Monitor for macular hole as increased risk secondary to commotio retinae e. Follow-up in 1-2 days