Eye Injuries

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.