To the Editor.—I read with great interest the communication by Arts et al1 regarding ocular injury in the setting of orbital fractures. It is indeed important for the nonophthalmologist to be able to judge clinically the likelihood of significant ocular injury in a given case. It appears that the described use of tonometric readings will help in predicting the presence of such injury, and thus the need for ophthalmic consultation.
However, since Schiotz tonometry is contraindicated in the presence of a ruptured globe, I strongly disagree that "manual palpation of the globe should be performed before tonometry." The digital pressure applied in such a maneuver is often greater than that produced by tonometry and could easily cause significant hemorrhage or extrusion of ocular contents.
If in doubt about the presence or absence of a rupture, I suggest the safest approach is to protect the eye with a Fox
BRALLIAR BB. Ocular Injury and Orbital Fractures. Arch Otolaryngol Head Neck Surg. 1989;115(8):994. doi:10.1001/archotol.1989.01860320104029
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