{"id":128399,"date":"2021-12-20T00:00:00","date_gmt":"2021-12-20T00:00:00","guid":{"rendered":"https:\/\/nursingstudybay.com\/2021\/12\/20\/shruthi-suresh-md-email-protected-gino-mongelluzzo-essay\/"},"modified":"2021-12-20T00:00:00","modified_gmt":"2021-12-20T00:00:00","slug":"shruthi-suresh-md-email-protected-gino-mongelluzzo-essay","status":"publish","type":"post","link":"https:\/\/www.studyproessays.com\/help\/shruthi-suresh-md-email-protected-gino-mongelluzzo-essay\/","title":{"rendered":"Shruthi Suresh MD [email\u00a0protected] Gino Mongelluzzo Essay"},"content":{"rendered":"
\n

Shruthi Suresh, MD [email\u00a0protected]<\/a><\/p>\n

Gino Mongelluzzo, MD [email\u00a0protected]<\/a><\/p>\n

27 year-old male with eye pain<\/p>\n

Page 1 \u2013 Contributor information, patient history, images, questions<\/p>\n

Our appreciation is extended to Dr. [Shruthi Suresh], [Department of Trauma Surgery] and Dr. Mongelluzzo [Department of Diagnostic Radiology] in [Danville,PA], [United States of America], for contributing this case.<\/p>\n

History: 27 year old male who is brought to the trauma bay complaining of severe right eye pain, photophobia and loss of vision. Additional history is purposely withheld.<\/p>\n

<\/div>\n

He subsequently underwent a head CT scan.<\/p>\n

Image 1<\/h2>\n

Image 2<\/h2>\n

Which choice best characterizes the salient findings?<\/p>\n

Calcified Optic glioma<\/h3>\n

Orbital Cellulitis<\/h2>\n

Mastoiditis<\/h2>\n

Globe rupture<\/h2>\n

What is the salient finding?<\/h3>\n

Subcutaneous air<\/h2>\n

Rupture of the right lateral rectus<\/h3>\n

Intraocular foreign body<\/h3>\n

Displacement of lens<\/h2>\n

The differential diagnosis should include which of the following?<\/p>\n

Intraocular gas tamponade<\/h3>\n

Intracranial tumor<\/h2>\n

Preseptal cellulitis<\/h2>\n

Optic nerve transection<\/h3>\n

All of the above<\/h2>\n

Globe rupture typically occurs exactly at the point of impact when there is blunt trauma to the eye.<\/p>\n

<\/div>\n

F<\/p>\n

Severe episcleritis or glaucoma can lead to globe rupture in the absence of trauma. T<\/p>\n

There is enlargement of the anterior chamber. T<\/p>\n

Page 2 \u2013 Additional images and questions (if needed)<\/p>\n

Image 3<\/h2>\n

Image 4<\/h2>\n

There is an additional foreign body that can be seen. T<\/p>\n

What are additional salient findings that can be found?<\/p>\n

Dislocation of the lens<\/h3>\n

Anterior hyphema<\/h2>\n

Staphyloma<\/h2>\n

Fracture of the right lateral orbit<\/h3>\n

All of the above<\/h2>\n

Image 1: Axial view of right globe rupture with intra-ocular foreign body<\/p>\n

Image 2: Frontal view of right globe rupture with intra-ocular foreign body<\/p>\n

Image 3: Axial view of a nondisplaced fracture involving the right lateral orbit\/zygoma with multiple foreign bodies in the adjacent temporalis muscle<\/p>\n

Image 4: Frontal view of a nondisplaced fracture involving the right lateral orbit\/zygoma with multiple foreign bodies in the adjacent temporalis muscle<\/p>\n

Findings<\/h2>\n

Differential diagnosis<\/h3>\n

\u0095 Penetrating laceration of right globe with rupture and intraocular foreign body from a ricocheted bullet<\/p>\n

\u0095 Intraocular gas tamponade<\/p>\n

\u0095 Emphysematous endophthalmitis<\/p>\n

\u0095 Choroidal Melanoma<\/p>\n

\u0095 Uveal hemorrhage<\/p>\n

Diagnosis:<\/h2>\n

Penetrating laceration of right globe rupture with intraocular foreign body from a ricocheted bullet<\/p>\n

What is the Zone of injury?<\/h3>\n

Zone 1<\/h2>\n

Zone 2<\/h2>\n

Zone 3<\/h2>\n

What is the prognosis with respect to recovery of vision after this type of injury?<\/p>\n

Good<\/p>\n

Poor<\/p>\n

Ocular ultrasound is a useful imaging technique to evaluate for vitreous hemorrhage after the diagnosis of ruptured globe has been made on CT. F<\/p>\n

Clinical Presentation and management<\/h3>\n

\u0095 Patients typically present with severe eye pain and photophobia<\/p>\n

\u0095 Ophthalmologic emergency that requires urgent surgical treatment and closure, particularly in the setting of a foreign body, which dramatically increases risk of endophthalmitis<\/p>\n

\u0095 If not obvious on physical exam due to posterior rupture or accompanying photophobia a CT is the best imaging study to evaluate for injury.<\/p>\n

\u0095 Typically an eye shield is placed over the eye to avoid further application of pressure, broad spectrum antibiotics are initiated to decrease the risk of endophthalmitis and antiemetic\/sedative therapies initiated to avoid actions that may lead to unpredictable increases in intraocular pressure.<\/p>\n

\u0095 Ultrasound of the eye is contraindicated in traumatic globe rupture as additional pressure to the globe may cause herniation of intraocular structures.<\/p>\n

\u0095 CT is more sensitive than ultrasound for globe rupture.<\/p>\n

Diagnosis on Imaging<\/h2>\n

\u0095 Globe collapse, enlarged anterior chamber, foreign body and intraocular gas are important signs that indicate globe rupture<\/p>\n

\u0095 The enlarged anterior chamber appearance is secondary to the lens leaning on its suspensory ligaments due to a decrease in pressure within the vitreous chamber<\/p>\n

\u0095 Vitreous and choroid detachment are common findings associated with globe laceration.<\/p>\n

\u0095 Prominent choroidal detachment superiorly and inferiorly can produce a \u0093kiss\u0094 sign.<\/p>\n

\u0095 In the presence of foreign bodies it is important to look for damage to surrounding structures (i.e. muscles, nerves and the orbit)<\/p>\n

Mechanism, terminology and epidemiology<\/p>\n

\u0095 Mechanical trauma is the most common of electrical, chemical and thermal injuries<\/p>\n

\u0095 Closed globe injury has a far better prognosis than open globe injury and often does not require surgical intervention<\/p>\n

\u0095 The most common cause of globe rupture is secondary to blunt trauma.<\/p>\n

\u0095 Rupture typically occurs secondary to elevated intraocular pressure after trauma and occurs at the thinnest points which is most commonly where the sclera attaches to the limbus or the extraocular muscles (inside-out).<\/p>\n

\u0095 Globe lacerations typically occur due to direct contact with a sharp object or a project ( help with nursing paper writing from experts with MSN & DNP degrees)ile and the trajectory of injury is outside-in.<\/p>\n

\u0095 Use of BB guns with recreational shooting, glass from car accidents and fights in teenage boys are common causes of these type of injuries.<\/p>\n

\u0095 Injuries may either be penetrating, which means the foreign body enters the globe but does not exit, or perforating where there are both entry and exit sites.<\/p>\n

Treatment and Prognosis<\/h3>\n

\u0095 The zone of these injuries are crucial to the prognosis of recovery of vision.<\/p>\n

\u0095 Zone 1 occurs at the joining of the cornea and sclera but does not penetrate this region.<\/p>\n

\u0095 Zone 2 injuries refer to laceration or rupture that occur in the anterior 5mm of the sclera.<\/p>\n

\u0095 Zone 3 injuries refer to a full thickness laceration or rupture that extends more than 5mm posteriorly from the limbus.<\/p>\n

\u0095 Zone 3 injuries have the worst prognosis<\/p>\n

References<\/h2>\n

Andreoli CM, Gardiner MF. Open globe injuries: Emergency Assessment and initial management. UpToDate. rupture&source=search_result&selectedTitle=1~22&usage_type=default&display_rank=1#references. Published February 2019. Accessed March 26, 2019<\/p>\n

Birinyi F, Mauger TF, Hendershot AJ. OPHTHALMIC CONDITIONS. In: Knoop KJ, Stack LB, Storrow AB, Thurman R. eds. The Atlas of Emergency Medicine, 4e New York, NY: McGraw-Hill;<\/p>\n

Accessed March 26, 2019.<\/p>\n

Ophthalmology. In: Brunette DD. eds. Extraordinary Cases in Emergency Medicine New York, NY: McGraw-Hill; . Accessed March 26, 2019.<\/p>\n

Carvounis PE, Chu YI. Eye. In: Moore EE, Feliciano DV, Mattox KL. eds. Trauma, 8e New York, NY: McGraw-Hill; . Accessed March 26, 2019.<\/p>\n

Go S. Eye Emergencies. In: Cydulka RK, Fitch MT, Joing SA, Wang VJ, Cline DM, Ma O. eds. Tintinalli\u2019s Emergency Medicine Manual, 8e New York, NY: McGraw-Hill; . Accessed March 26, 2019<\/p>\n

Kubal, W. S. (2008). \u201cImaging of orbital trauma.\u201d Radiographics 28(6): 1729-1739.<\/p>\n

Lazzaro DR. Chapter 8. Ophthalmology. In: Shah BR, Lucchesi M, Amodio J, Silverberg M. eds. Atlas of Pediatric Emergency Medicine, 2e New York, NY: McGraw-Hill; 2013. Accessed March 26, 2019.<\/p>\n

Lyon M, von Kuenssberg Jehle D. Chapter 19. Ocular. In: Ma O, Mateer JR, Reardon RF, Joing SA. eds. Ma and Mateer\u2019s Emergency Ultrasound, 3e New York, NY: McGraw-Hill; 2014. Accessed March 26, 2019<\/p>\n

Weaver CS, Knoop KJ. OPHTHALMIC TRAUMA. In: Knoop KJ, Stack LB, Storrow AB, Thurman R. eds. The Atlas of Emergency Medicine, 4e New York, NY: McGraw-Hill; . Accessed March 26, 2019<\/p>\n<\/article>\n","protected":false},"excerpt":{"rendered":"

Shruthi Suresh, MD [email\u00a0protected] Gino Mongelluzzo, MD [email\u00a0protected] 27 year-old male with eye pain Page 1 \u2013 Contributor information, patient history, images, questions Our appreciation\u2026<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[7641,8827,10535,10533,10534,10531,10529,6744,10532,10530,7741],"tags":[10553,10549,10616,10615,7687,10254,10627,10104,10247,8857,10552,10295,10900,2984,3903,10548,10622,8901,10551,8907],"class_list":["post-128399","post","type-post","status-publish","format-standard","hentry","category-australia-essay-writers","category-australia-essays","category-do-my-university-assignment-for-me","category-essay-pro-dissertation-writers","category-homework-help-services-best-websites","category-i-need-help-writing-a-page-paper-assignment","category-masters-essays","category-nursing-studybay","category-pay-someone-to-write-a-paper-for-you","category-website-that-writes-assignments","category-studybay","tag-1-assignment-help-online-service-for-students-in-the-usa","tag-ai-plagiarism-free-essay-writing-tool","tag-australian-best-tutors","tag-best-trans-tutors","tag-buy-essay-uk","tag-can-someone-write-my-assignment-for-me","tag-cheap-dissertation-writer","tag-essypro","tag-help-me-write-my-dissertation","tag-help-with-writing-an-essay","tag-help-write-my-paper-ai-free","tag-homework-for-you","tag-nursing-bay","tag-nursing-essay","tag-nursing-study-bay","tag-online-essay-writers","tag-phd-essays","tag-studbay","tag-write-my-assignment-help-for-college-students","tag-write-my-essay-for-me"],"_links":{"self":[{"href":"https:\/\/www.studyproessays.com\/help\/wp-json\/wp\/v2\/posts\/128399","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.studyproessays.com\/help\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.studyproessays.com\/help\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.studyproessays.com\/help\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.studyproessays.com\/help\/wp-json\/wp\/v2\/comments?post=128399"}],"version-history":[{"count":0,"href":"https:\/\/www.studyproessays.com\/help\/wp-json\/wp\/v2\/posts\/128399\/revisions"}],"wp:attachment":[{"href":"https:\/\/www.studyproessays.com\/help\/wp-json\/wp\/v2\/media?parent=128399"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.studyproessays.com\/help\/wp-json\/wp\/v2\/categories?post=128399"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.studyproessays.com\/help\/wp-json\/wp\/v2\/tags?post=128399"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}