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Traumatic eye injuries

Last updated: February 16, 2021

Summarytoggle arrow icon

The eye is a highly sensitive organ that is well-protected by the bony orbit and eyelid. Common traumatic eye injuries occur through blunt or sharp objects or chemical burns. Closed globe injuries usually follow blunt trauma and have a varied clinical presentation (superficial corneal abrasion to retinal hemorrhage). Open globe injuries usually follow sharp or high-velocity blunt trauma and present with ocular volume loss or a prolapsing uvea in addition to the sequelae of closed ocular injuries. Orbital floor fractures are a type of periocular injury following high-velocity blunt trauma to the globe and upper eyelid which present with unilateral periorbital pain, edema, and/or ecchymosis, enophthalmos, and an orbital rim “step-off” which is confirmed by CT. Chemical burns of the eye present with ocular pain, erythema, and blepharospasm. Treatment of traumatic eye injuries depends on the precise underlying injury. Chemical burns require immediate and adequate irrigation with water beginning prior to hospitalization. Urgent stabilization, antibiotics, and immediate ophthalmologic consultation is often required to rule out serious injury (e.g., severe chemical burns, open globe injuries, retinal detachment, extraocular muscle entrapment) and determine the need for surgery.

Clinical features
Early sequelae
Late sequelae
  • Diagnosis
  • Treatment
    • Frequent ophthalmologic assessment
    • Eye immobilization if necessary (with a binocular bandage)
    • Specific treatment depends on the precise injury

References:[1][2][3][4][5]

  • Definition: : full-thickness perforation or laceration of the ocular globe
  • Mechanism of injury: sharp objects or high-velocity blunt objects
  • Clinical features [6]
  • Diagnosis
    • Careful investigation of the anterior and posterior segment of the eye (by slit lamp and fundoscopy, respectively)
    • Fluorescein stain if inconclusive: corneal abrasions and foreign bodies
    • Nonenhanced CT can be used if the eye cannot be directly visualized or to exclude the possibility of an intraocular foreign body.
    • Culture of the vitreous if a foreign body or infection is suspected
  • Treatment [7]
  • Complications [8]
    • Permanent vision loss
    • Loss of eye
    • Endophthalmitis: inflammation of the tissues or fluid inside the eye (especially with retained intraocular foreign bodies), often presenting with deep ocular pain, a red eye, and reduced visual acuity
    • Sympathetic ophthalmia: bilateral granulomatous panuveitis after unilateral penetrating injury (and rarely after intraocular surgery) → bilateral blindness may occur

Avoid topical ointments in the presence of open globe injuries.

References:[9][10][11]

Patients should be advised to irrigate with a copious volume of water or saline for at least 15 minutes before arrival to the ED because immediate irrigation is the most important factor in preventing morbidity!
References:[12][13][14]

  1. Papadakis MA, McPhee SJ, Rabow MW. CURRENT Medical Diagnosis and Treatment 2017. Lange ; 2016
  2. Commotio Retinae. https://www.aao.org/bcscsnippetdetail.aspx?id=b791267d-8088-4abb-bde3-6f662cf1fb9f. Updated: February 17, 2017. Accessed: February 17, 2017.
  3. Gentile RC, Shah CM. A Baseball Takes a Bad Hop and a LASIK Is Undone. A Baseball Takes a Bad Hop and a LASIK Is Undone. New York, NY: WebMD. http://www.medscape.com/viewarticle/850625_2. Updated: August 14, 2015. Accessed: March 15, 2017.
  4. Nash DL. Hyphema. Hyphema. New York, NY: WebMD. http://emedicine.medscape.com/article/1190165-overview. Updated: December 14, 2016. Accessed: March 15, 2017.
  5. Cuneyt Erdurman F, Sobaci G, Acikel CH, Ceylan MO, Durukan AH, Hurmeric V. Anatomical and functional outcomes in contusion injuries of posterior segment. Eye. 2011; 25 (8): p.1050-1056. doi: 10.1038/eye.2011.118 . | Open in Read by QxMD
  6. Neuman MI, Bachur RG. Orbital fractures. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/orbital-fractures?source=see_link.Last updated: September 28, 2015. Accessed: February 17, 2017.
  7. Orbital blow-out fracture. https://radiopaedia.org/articles/orbital-blow-out-fracture. Updated: February 17, 2017. Accessed: February 17, 2017.
  8. Cohen AJ. Orbital Floor Fractures (Blowout). Orbital Floor Fractures (Blowout). New York, NY: WebMD. http://emedicine.medscape.com/article/1284026. Updated: January 30, 2017. Accessed: February 17, 2017.
  9. Ocular penetrating and perforating injuries. http://eyewiki.aao.org/Ocular_penetrating_and_perforating_injuries. Updated: December 21, 2014. Accessed: February 17, 2017.
  10. Yonekawa Y, Chodosh J, Eliott D. Surgical techniques in the management of perforating injuries of the globe. Int Ophthalmol Clin. 2013; 53 (4): p.127-137. doi: 10.1097/IIO.0b013e3182a12b01 . | Open in Read by QxMD
  11. Du Toit N, Mustak H, Cook C.. Visual outcomes in patients with open globe injuries compared to predicted outcomes using the Ocular Trauma Scoring system. Int J Ophthalmol. undefined; 8 (6): p.1229-1233.
  12. Solano J. Ocular Burns. Ocular Burns. New York, NY: WebMD. http://emedicine.medscape.com/article/798696. Updated: April 7, 2015. Accessed: February 17, 2017.
  13. Kaushik S, Bird S. Topical chemical burns. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/topical-chemical-burns.Last updated: September 8, 2016. Accessed: February 17, 2017.
  14. . Ophthalmologic Approach to Chemical Burns. Ophthalmologic Approach to Chemical Burns. New York, NY: WebMD. http://emedicine.medscape.com/article/1215950. Updated: May 13, 2016. Accessed: March 15, 2017.