GCA is a is a vasculitis generally seen in the over 50’s and associated with polymyalgia rheumatic (PMR). However, unlike a lot of rheumatology, GCA is far from a benign condition that can be passed back to the GP’s, it can lead to some significant problems
Like tension pneumothorax the biggest step is deciding to do it – Remember it it sight saving and they heal well
Retrobulbar Haematoma secondary to blunt eye injury is a a rare but potentially sight threatening injury.
Blood collects in the retrobulbar space
Pushing the eye forward to accommodate the extra volume.
The Orbital Septum (made up of the eyelids and ligaments that attach them to the orbital rim) restricts this forward movement, creating a compartment syndrome for the eye. Thus threatening the patients sight if not treated quickly.
Exophthalmos with proptosis – eye pushed forward
Internal ophthalmoplegia – impairment or loss of the pupillary reflex.
Loss of vision – initially colour vision (esp. red), progressing to local visual loss.
However, this may only be recognised on CT if there is significant facial injury and altered conscious level.
Call Ophthalmology immediately to attend. If there is going to be any significant delay, it may be necessary for ED to preform a Lateral Canthotomy, to allow the eye to move forward, reduce the orbital pressure & preserve the patients sight.