Introduction
Eye injury is a broad term used to describe a physical or chemical wound to the eye or eye socket.
Injuries to the eye could be caused by blunt or sharp objects or chemicals
Aetiology
- Blunt injuries e.g. a fist or a ball hitting the eye
- Sharp injuries e.g. glass, metal, broom sticketc
- Chemicals e.g., alkali or acid
Clinical features
Blunt injury
- Eyelids: peri-orbital haematoma and oedema
- Conjunctivae: subconjunctival haemorrhage and chemosis
- Cornea: abrasion or oedema
- Anterior chamber: hyphaema from tears of the iris or cilliary body.
- Iris: traumatic mydriasis
- Traumatic uveitis
- Angle recession
- Lens: dislocation into anterior or posterior chambers; cataract
- Vitreous haemorrhage
- Retina: peripheral tear leading to retinal detachment; oedema with haemorrhage (Commotio Retinae)
- Choroid: tear with haemorrhage
- Rupture of the eyeball, usually posteriorly (rare)
- Optic nerve: avulsion
- Blow out fracture of the orbital wall
Sharp Injury
- Lacerations of eyelids, conjunctivae, cornea,
sclerae, or corneo-sclera - Uveal prolapse with or without lens extrusion
- Intraocular foreign body
- Endophthalmitis
Chemical burns.
Acid or alkali e.g. cement or lime are alkaline.
Acids coagulate surface proteins.
Alkalis penetrate into the anterior chamber causing uveitis.
- Symblepharon: adhesions between bulbar and tarsal conjunctivae
Differential diagnoses
- Conjuctivitis
- Endophthalmitis
- Orbital cellulitis
Complications
- Ruptured globe
- Endophthalmitis
- Reversible blindness (compression of optic nerve by orbital haematoma)
- Irreversible blindness (optic nerve avulsion)
- Corneal opacity/scarring
Investigations
- Orbital radiographs
- Orbital ultrasound
Management
Blunt injuries
- Treat individual injury
Sharp injuries
- Suture lacerations.
- Remove intraocular foreign bodies with magnet if possible, or by vitrectomy
- Parenteral antibiotics, if infected
- Evisceration (removal of the contents of the eyeball) if ruptured globe, or if infection not settling on antibiotics
Chemical burns
- Copious rinsing of eyeball and fornices with sodium chloride 0.9% or clean water at site
- In hospital, copious rinsing again, to dilute offending agent
- Remove particles from eye e.g. lime or cement
- Antibiotic ointment
- Rodding of fornices with ointment to prevent symblepharon
- Topical steroids for uveitis once cornea is re-epithelized
- Vitamin C (ascorbic acid)
Caution and contraindications
- Avoid the use of topical steroids in active corneal ulceration.
- Avoid the use of harmful traditional eye medications; using this may cause more complications
Prevention
- Wearing of appropriate protective eye goggles for sports, welding and when working with chemicals.