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Trauma To The Eye

Introduction

Trauma to the eye needs to be taken very seriously.

Here are some statistics of trauma to the eyes (ocular trauma). Depending on the injury it could be very superficial like a laceration to the upper eye lid, which only needs a few sutures in the hospital Emergency Room.

An eye lid laceration that involves the margin of the eye-lid needs a complicated plastic surgical repair utilizing an operating microscope that should be done by an eye surgeon. The eye injury could involve a metal foreign body that perforated the cornea and entered deep into the eye (“intraoccular foreign body”), which is an acute ophthalmic emergency where an eye surgeon has to explore the eye and carefully check that the anatomy of the lens, the vitreous and the retina have not been disrupted.

There can also be a blunt eye injury (e.g. airbag injury) or a burn injury, which all need to be carefully evaluated.

Prevention of eye injuries is of the utmost importance.

Signs and symptoms

Symptoms vary depending on what the underlying mechanism of eye injury was. With a chemical injury there would be a burning pain, redness and swelling. With a small abrasion of the cornea from a contact lens injury there would be a foreign body feeling, eye redness and pain. Here are many more symptoms of eye injuries listed and the underlying corresponding injuries.

Diagnostic tests

Ultrasound biomicroscopy is a newer tool that can be utilized to examine traumatic damage to structures of the eye. Here is an image of the normal eye anatomy using this technology.

Otherwise the standard diagnostic tests for eye diseases are done. Direct physical examination amplified by direct ophthalmoscopy and slit lamp examination helps the physician to evaluate most eye injuries. Intraoccular pressure is tested. Ophthalmic ultrasound is useful for the detection of any unusual intraoccular mass. To check for the integrity of the retinal blood vessels, a dye can be injected intravenously and subsequently pictures of the fluorescein stained blood vessels can be taken. For deeper injuries CT scans and MRI scans may be required. With this technology we can look through the head of an injured person from the back to the front. We see the brain cavity on top and the left and right eye cavities underneath. The sinus cavities are underneath the eye cavities with the nasal cavity between and the mouth cavity underneath in the center. When the eye cavity has a fracture on the bottom, orbital fat tissue can herniate into the sinus cavity underneath. This is called a “blowout fracture” of the eye cavity and would be typical for a fist fight or when a shrapnel from a gunshot wound had entered the eye cavity. Both CT and MRI scans will depict this reliably.

 Trauma To The Eye

Trauma To The Eye

Treatment

The first seconds and minutes count most after an eye injury. If the eye was injured from a lie (=alkaline chemical compound) the eye needs to be washed for at least 5 minutes (better up to 15 or 20 minutes) with tap water. One way to do this is to simply fill a sink with water and open and close the eyes many times to dilute the chemical and flush it out at the same time. Have the patient assessed by an ophthalmologist on an emergency basis.

Eye lid lacerations: If the margin of an eye lid is lacerated, an eye surgeon needs to be consulted for an exact repair with the help of the operating microscope.

Metal foreign body in the cornea: Under an anesthetic the foreign body is removed and any rust spot (from iron or steel piece) has to be carefully removed.

Corneal ulcer: If the person wears a contact lens, this has to be removed and the eye is treated with Polytrim or erythromycin ointment and followed every day by the eye specialist until healed. There is a great danger that the cornea perforates, if his is not carefully followed up.

Penetrating Wounds of the Eye:

Some of these injuries can be very ugly. Here is a text that deals with this topic in more detail.

Burns of the eye: It has to be identified what has been burnt. If there was exposure to extreme heat, the eye lids will have suffered burns, but the cornea can also suffer some degree of burning. These injuries are complicated and need close supervision by an eye specialist, often with hospitalization for several days.

Various sports injuries: In this link to common sports injuries it is described what tests and procedures need to be done to remedy the situation as much as it can be remedied.

 

References:

1. The Merck Manual: Blunt injuries to the eye.

2. Ferri: Ferri’s Clinical Advisor: Instant Diagnosis and Treatment, 2004 ed., Copyright © 2004 Mosby, Inc.

3. Rakel: Conn’s Current Therapy 2004, 56th ed., Copyright © 2004 Elsevier

Last modified: December 2, 2016

Disclaimer
This outline is only a teaching aid to patients and should stimulate you to ask the right questions when seeing your doctor. However, the responsibility of treatment stays in the hands of your doctor and you.