ATLS Ocular and Facial Trauma 1 — Questions and Answers
Question 1: A patient presents with a blunt eye injury and decreased visual acuity. On exam, blood is visible in the anterior chamber. What is this condition called?
- Hyphema (Correct answer)
- Vitreous hemorrhage
- Retinal detachment
- Corneal abrasion
Correct answer: Hyphema
Hyphema is the accumulation of blood in the anterior chamber of the eye, commonly caused by blunt trauma.
Question 2: Which finding on examination of an eye injury warrants immediate ophthalmology consultation for possible open globe?
- Teardrop-shaped pupil (Correct answer)
- Subconjunctival hemorrhage
- Periorbital ecchymosis
- Eyelid laceration
Correct answer: Teardrop-shaped pupil
A teardrop-shaped or peaked pupil suggests iris prolapse through a scleral or corneal laceration, indicating an open globe injury.
Question 3: What is the initial management priority for a patient with a suspected open globe injury?
- Apply a rigid eye shield without pressure (Correct answer)
- Apply a pressure patch to both eyes
- Irrigate the eye with saline
- Attempt to remove any visible foreign body
Correct answer: Apply a rigid eye shield without pressure
A rigid eye shield protects the globe from further pressure while avoiding compression that could extrude intraocular contents.
Question 4: A 28-year-old sustains midface trauma and cannot open his mouth fully. CT shows comminuted fractures of the zygomatic arch bilaterally with posterior displacement. Which muscle movement is most impaired?
- Masseter action during mouth opening (Correct answer)
- Tongue protrusion
- Orbicularis oculi closure
- Frontalis elevation
Correct answer: Masseter action during mouth opening
Displaced zygomatic arch fragments can impinge on the coronoid process of the mandible, mechanically blocking mouth opening.
Question 5: Le Fort II fractures are characterized by which of the following?
- Pyramidal fracture through the nasal bridge and orbital floors, separating the midface (Correct answer)
- Horizontal fracture separating the entire maxilla at the base
- Fracture through the lateral orbital walls and zygomatic arches
- Isolated nasal bone fracture only
Correct answer: Pyramidal fracture through the nasal bridge and orbital floors, separating the midface
Le Fort II (pyramidal) fractures extend through the nasal bones, medial orbital walls, orbital floors, and lateral maxillary sinuses.
Question 6: During trauma assessment, a patient has clear fluid draining from one nostril after a facial fracture. What is the most concerning etiology?
- Cerebrospinal fluid rhinorrhea from a basilar skull fracture (Correct answer)
- Normal serous nasal secretions from mucosal irritation
- Blood-tinged saline from nasal irrigation
- Lacrimal duct injury
Correct answer: Cerebrospinal fluid rhinorrhea from a basilar skull fracture
CSF rhinorrhea following facial trauma indicates a dural tear and communication between the subarachnoid space and nasal cavity.
ATLS Ocular and Facial Trauma 1
A patient presents with a blunt eye injury and decreased visual acuity.
On exam, blood is visible in the anterior chamber.
What is this condition called?