Trauma to the Eye (Eye Injuries)

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[edit] Trauma to the eye (eye injuries)

Introduction:

Any traumatic injury to the eye needs to be taken seriously. Here are some statistics of trauma to the eyes (ocular trauma). There are about 2.4 million eye injuries of various severity in the US annually. Depending on the type of 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 (ophthalmologist). The eye injury could involve a metal foreign body that perforated the cornea and entered deep into the eye ("intraocular 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, pain and light sensitivity. 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.

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. Here,for example, is an image of a subluxation of the lens using this technology. Intraoccular pressure is tested. Ophthalmic echography 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. As an example, here is a link showing a fracture at the bottom of the eye cavity . For the untrained observer this needs a brief explanation: We are looking 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. The left eye cavity has a fracture on the bottom where orbital fat tissue has herniated into the sinus cavity underneath. It is clear from a comparison between the right and left sinus cavities that in the left there is blood (gray color) on the bottom and air (black) on top. In the corresponding right sinus cavity the space is empty (only black colored air). This is called a "blowout fracture" of the left eye cavity and would be typical for a fist fight or when a shrapnel from a gunshot wound had entered the eye cavity.

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. Here are some other first aid suggestions.

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.

Prevention of eye injuries: Here are some practical suggestions of how to avoid serious eye injuries.

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Eye diseases

References:

1. The Merck Manual: Eye disorders

2. Eye conditions: http://www.stlukeseye.com/Conditions/

3. Karolinska Institute Library eye disease links

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

5. Rakel: Conn's Current Therapy 2004, 56th ed., Copyright © 2004 Elsevier