Bullous Subconjunctival Hemorrhage ... Bullous subconjunctival hemorrhage in this patient resulted from a fall and may signify severe orbital ...OphthalmologyandVisualSciencesHomeCasesAtlasVideosTutorialsAboutUsSiteNavigationSearchEyeRoundsCaseReportsAtlasTutorialsVideosAboutUsmoreCataractSurgeryforGreenhornsEyeTransilluminationGonioscopy.orgIowaGlaucomaCurriculumIowaWetLabPatientInformationAssessmentandManagementofOcularTraumaWrittenbySudeepPramanik,M.B.A.,M.D.WithcontributionsbyAndrewDoan,M.D.,Ph.D.andThomasA.Oetting,M.D.ThisguidewaswrittenforthebenefitofUniversityofIowaresidentsandmedicalstudentstolearnaboutassessmentandmanagementofopenglobesandoculartrauma.Wehopeitmayhelpothers.INITIALEXAMOFOCULARANDADNEXALINJURIESOPENGLOBESIfyoususpectanopenglobe,youmayperformaquickexambeforetakingthefullhistory.Iftheglobeisruptured,calltheseniorresidentandfinishthehistory/paperworkwhilebackupisonitsway.Makesurethepatienthasupdatedtetanusimmunization,orderIVantibiotics/narcotics/antiemetics,callOR/anesthesia,askabouttimeoflastmeal,andprepareadmissionpaperwork.Placeshieldovereyewhennotexamining.DoNOTpatchtheeye;instructtransferringcaregiverNOTtopatchtheeye.Inspecteyeswithoutplacingpressureontheglobe(e.g.,useDesmarresretractors).Signsofopenglobeinclude:penetratinglidinjury,bulloussubconjunctivalhemorrhageshallowanteriorchamberbloodintheanteriorchamber(hyphema),peakedpupilirisdisinsertion(iridodialysis)lensdislocation,andvitreoushemorrhage.Lossofredreflexcanindicatevitreoushemorrhageorretinaldetachment.Palpatefordiscontinuityoftheorbitalrimanddetachmentofthemedialcanthaltendon,signsofsevereorbitaltrauma.ApositiveSeideltestwillhelpdetectleakingaqueousorexposedvitreous.Fluoresceinophthalmicstripsarewettedwithnormalsaline.Concentratedfluoresceinisdarkorange,butifitbecomesdilutedwithaqueous,itturnsbrightgreenunderbluelight.Thepresenceofanintraocularforeignbody(IOFB)suggestsglobepenetration.Plainfilmx-raysoftheheadand/orCTscanwillhelpdeterminethelocationandpresenceofametallicIOFB.DoNOT