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Contusion injuries of the eye and surrounding structures may cause ecchymosis ( black eye ), subconjunctival hemorrhage, edema or rupture of the cornea, hemorrhage into the anterior chamber (hyphema), rupture of the root of the iris (iridodialysis), paralysis of the pupillary sphincter, paralysis of the muscles of accommodation, cataract, dislocation of the lens, vitreous hemorrhage, retinal hemorrhage and edema (most common in the macular area), detachment of the retina, rupture of the choroid, fracture of the orbital floor ( blowout fracture ), or optic nerve injury Many of these injuries are immediately obvious; others may not become apparent for days or weeks The possibility of globe injury must always be considered in patients with facial injury, particularly if there is an orbital fracture Patients with moderate to severe contusions should be seen by an ophthalmologist Any injury causing hyphema involves the danger of secondary hemorrhage, which may cause intractable glaucoma with permanent visual loss (Plate 30) The patient should be advised to rest until complete resolution has occurred Daily ophthalmologic assessment is essential Aspirin and any drugs inhibiting coagulation increase the risk of secondary hemorrhage and are to be avoided Sickle cell anemia or trait adversely affects outcome
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Brophy M et al Pediatric eye injury-related hospitalizations in the United States Pediatrics 2006 Jun;117(6):e1263 71 [PMID: 16740824] Garcia TA et al Ocular injuries in children after major trauma J Pediatr Ophthalmol Strabismus 2005 Nov Dec;42(6):349 54 [PMID: 16382559] Girkin CA et al Glaucoma after ocular contusion: a cohort study of the United States Eye Injury Registry J Glaucoma 2005 Dec;14(6):470 3 [PMID: 16276279] Greven CM et al Circumstance and outcome of ocular paintball injuries Am J Ophthalmol 2006 Feb;141(2):393 [PMID: 16458707] Guly CM et al Ocular injuries in patients with major trauma Emerg Med J 2006 Dec;23(12):915 7 [PMID: 17130597]
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Intraocular foreign body requires emergency treatment by an ophthalmologist Patients giving a history of something hitting the eye particularly while hammering on metal or using grinding equipment must be assessed for this possibility, especially when no corneal foreign body is seen, a corneal or scleral wound is apparent, or there is marked visual loss or media opacity Such patients must be treated as for corneal laceration (see below) and referred without delay Intraocular foreign bodies significantly increase the risk of intraocular infection
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Bhogal G et al Penetrating ocular injuries in the home J Public Health (Oxf) 2007 Mar;29(1):72 4 [PMID: 17090631]
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A patient with a corneal abrasion complains of severe pain and photophobia There is often a history of trauma to the eye, commonly involving a fingernail, piece of paper, or contact lens Visual acuity is recorded, and the cornea and conjunctiva are examined with a light and loupe to rule out a foreign body If an abrasion is suspected but cannot be seen, sterile fluorescein is instilled into the conjunctival
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If the lid margin is lacerated, the patient should be referred for specialized care, since permanent notching may result Lacerations of the lower eyelid near the inner canthus often
Disorders of the Eyes & Lids
sever the lower canaliculus Lid lacerations not involving the margin may be sutured like any skin laceration
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B Conjunctiva
In lacerations of the conjunctiva, sutures are not necessary To prevent infection, sulfonamides or other antibiotics are instilled into the eye until the laceration is healed
temic vitamin C are also necessary Complications include mucus deficiency, scarring of the cornea and conjunctiva, symblepharon (adhesions between the tarsal and bulbar conjunctiva), tear duct obstruction, and secondary infection It can be difficult to assess severity of chemical burns without slit-lamp examination
Ikeda N et al Alkali burns of the eye: effect of immediate copious irrigation with tap water on their severity Ophthalmologica 2006;220(4):225 8 [PMID: 16785752]
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