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This is due to a relatively high density of sensory pain fibers in the facial and orbital regions, thus making pain symptoms significant. Orbital fractures can be obvious, but frequently are subtle and can therefore present a diagnostic challenge. If any suspicion for fracture is present, it's appropriate to order a CT scan to determine if orbital trauma exists.

However, if a patient exceeds the capacity of the low-volume trauma center, imaging should be deferred, especially if life threats are present. If the patient is unconscious, diagnosis is even more problematic absent patient interaction, and orbital injuries can be overlooked. Missing an orbital or ocular injury at the outset is also possible in polytrauma cases, where the primary focus is the trauma ABCs — concerns that might rapidly take the patient's life.

When a patient arrives with an obvious eye injury, a robust general trauma assessment is the first step in caring for the patient. Once more-serious injuries have been ruled out or addressed, one may consider evaluation and treatment of the ocular trauma. Evaluation of visual acuity, detection of soft tissue injuries, observation of epiphora, evaluation of extraocular muscle function and globe position, and palpation for bony deformities should proceed in a systematic manner.

With corneal abrasion, which is very common in orbital trauma, patients can be profoundly uncomfortable, making pain control particularly important. If there's a potential orbital floor injury, it's critical the patient avoids or takes great care with nose blowing, so nasal bacteria are not passed upward into the orbit. If the orbital injury is connected in any manner to the sinus or nasal cavity, administer antibiotics. After the primary trauma evaluation to rule out life-threatening injuries, attention can be focused on any injury that might threaten the patient's vision or eye function, which would require rapid consult with an ophthalmologist.

Examples of these types of injuries include: Retrobulbar hemorrhage: This bleeding behind the globe is an emergent issue, as the pressure in the eye socket can become so high that it hinders any blood flow to the retina, resulting in retinal ischemia and blindness. Extraocular muscle entrapment from orbital floor fracture in a child: This is indicated by inability to move the eye in upward gaze, or sometimes downward gaze, and one may observe autonomic instability, the oculocardiac reflex. Patients less than approximately 10 years of age may need emergent surgery to release the muscle from the fracture to prevent acute hemodynamic instability as well as long-term ocular motility problems.

In cases where orbital fracture causes only facial contour deformity, this is a cosmetic problem, rather than functional — the patient is seeing fine and has no double vision, vision loss or other vision impairment — nonsurgical treatment is also a consideration. An older adult patient, for instance, may have other illnesses and be too fragile to have surgery for cosmetic reasons alone and frequently will be unimpressed by esthetic concerns.

Other patients may not be bothered by a slight cheekbone flattening from the trauma and will not elect surgery. However, surgical repair is often performed in young patients with orbital region cosmetic changes. Long-term functional effects of ocular or orbital injury are infrequent when appropriate treatment is rendered in the acute phase, or within the first three to four weeks of injury. Cosmetic effects, however, may still be present at some level. Other long-term effects of these traumas are functional, such as vision loss or chronic double vision.


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These issues hinder a patient's ability to drive, fly a plane or even work, if vision is an essential part of one's job. Viozzi notes there are very few jobs where visual loss is not severely impactful of full employment. Whether or not a patient with an ocular or orbital injury should be transferred to a higher level of care is highly dependent on the resources at the particular facility where the patient first arrives.

A small hospital often will have very well-trained surgeons or ophthalmologists who can manage these injuries, according to Dr. So, knowing this and who she is, do you still want to help her? Because remember. Even if she is… not a kind person. I think she can become better.

Rafiki smiled, but it was not an all happy. He was happy to hear that his apprentice was willingly to see good in everyone, even a lioness like Aina. He had also been alive long enough to see that personality traits sometimes could pass down from one generation to another, for good or worse. But however this went, this was something Makini would have to learn one day or another.

Rafiki just hoped she was ready for it. Well nope. I was asked at one point if Rafiki knew about Hasani, and yes he do. And now you may also have an idea of why Aina had not returned to Pride Rock at the end of Aftermath.

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Consider to supporting me on Patreon and get accesses to previews and story part weeks before it's uploaded on DA. And besides, Aina realized. Add a Comment:. Load All Images. Patilion Featured By Owner 1 day ago.

A Battle for My Life

I don't know how, but you always make something great with the story. Makini is going to help her change? OMG this will be gold to see. Irete Featured By Owner May 28, Indeed they will not, especially since Vizuri ended up leaving and never came back. Which Aina doesn't know yet. Looks like Aina is finally listening to someone's advice with no arguments, despite her staying in the tree is to avoid the consequences from Kiara and Kovu for what she said to Vizuri, I have a feeling she and Makini will become true friends if Aina swallows her pride. No Aina, your mother is right, while Vizuri did attack you, YOU called her a murderer when she is still recovering from her grandpa's death, and accusing a member of the royal family of such a thing is treason, especially when the Royals made it clear Vizuri is innocent and Simba's death was an accident.

While Vizuri shares some of the blame for physical harm, you do to for making an accusation that in some Prides could get you executed or banished immediately. I wonder when Aina will learn the truth. I think if she does it will give her a wake up call and make her realize she and Vizuri aren't so different and if someone called her the daughter of a murderer, she would react the same way Vizuri did to and make her realize the pain her mother went through for years because of what her father did and how Aina made things difficult for her.

Well done! Thank you!

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Aina had been worse of in a more extreme pride. Aina didn't really care if Vizuri was innocent or not, she just wanted to get back at Vizuri for remarking how Aina lost her friends and threw out the words before thinking. Which turned out to be a very bad idea. At this point, Aina is in denial about herself being a bad person.

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So even if she did learn the truth now, she may not see the similarities between herself and her father, or admit that she and Vizuri are anything alike. Even if the gears have very slowly started to move, Aina will not change over night, it will take time for her to realize her flaws if she ever does. Yep, that experience will be her first warning that her actions will have consequences, and next time she might get killed. It will be a slow progress. Exactly, it will be a LONG process. That would be the proper term for it. Zuri knows her daughter would face more serious consequences than Vizuri would because what Aina did would constitute as false accusations to Regicide.

You don't go and accuse a royal of a crime like that without proof, and Vizuri was clear of it from the start and Aina ha to open her mouth, I'm amazed she wasn't killed yet for it, of course sh almost did with Vizuri. Aina really needs this reality check. I really like how Makini doesn't judge Aina besides what she did, she still seems to see both sides of the coin, I love that! Actually depicting Aina and Makini being sort of "friends" makes me smile Cant wait for the next part ;v; and to Aina to change Irete Featured By Owner May 27, Thanks I'm glad you like it.

Hehe, we'll see. Kelsey Featured By Owner May 20, Very nice part of the story But What a jerkass! I mean Aina I just hate this kind of people in a real world. Never their fault. Others are worst and they are the best of best. Irete Featured By Owner May 21, Yeah, I know what you mean. Aina's character is inspired from people I have known IRL.

I believe Aina has it in her to change and I look forward to it because I kind of like her,faults and all. Irete Featured By Owner May 22, Glad you like her. We'll see what happens. Well, Aina, your mother told you so: Rafiki was coming and you shouldn't have moved with open wounds, your very own fault if they got infected and your trip was for nothing.

Maybe if you would listen to others instead of despising everyone you wouldn't be in this mess. I just knew it: the coward just stayed in Rafiki's tree just to get away from further punishment. Worst of all is that she's still not admiting she did any wrong and even hoping they'll forget or "come to their senses".

Honestly, I do hope that she finds out that Vizuri ran away, and I hope that just because of that her punishment will come anyway I know she wasn't the main reason why Vizuri left, but still, she was the last straw. I love Makini, but she's too good even for her own good. Let's hope she has enough patience to deal with this brat.


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Yep, Zuri was about to send word to Rafiki to come to them, but Aina was angry and more focused on defying her mother than being practical at that point. I bet Aina doesn't have a gut to face consequences for her action. It's her fault for not listening to Zuri and having common sense. I guess she gets her bratty and stuck-up attitude from both of her parents. Irete Featured By Owner Jun 10, Indeed, she don't think that she being punished is fair either.

Irete Featured By Owner May 20, Glad you enjoy them. Bellateda Featured By Owner May 19, We'll see.

The Scarred Woman

The story made me chuckle a few times, which makes sense considering it's the mandrills, plus it accurately shows how wise they really are, which I don't often see when it comes to Lion King fics. But I do think that Aina will find out about her father eventually. Perhaps when she does, she'll realize she and Vizuri have something in common: a murderous ancestor. I'm glad you like it. I try my best to make the canon characters recognizable from the movies and TV-show.

You're welcome! I think she will eventually find whether she overheats it or someone will just shout it in face.