Section 20. Eye Disorders

Chapter 227. Eye Injuries

Topics: Introduction | Blunt Injuries | Foreign Objects | Burns

Blunt Injuries

A blunt impact may damage the structures near the surface of the eye (the eyelid, conjunctiva, sclera, cornea, iris, and lens) and those at the back of the eye (retina and optic nerve). Such an impact may also break the bones that surround the eye. Even blunt trauma may result in cuts (lacerations) to the tissues of the eye.

Symptoms

In the first 24 hours after a blunt eye injury, blood may leak into the skin of the eyelid and surrounding areas, producing a bruise (contusion), commonly called a black eye. If a blood vessel on the surface of the eye breaks, the conjunctiva will become red. The superficial bleeding may look alarming but is usually minor. It resolves without treatment. The red area may become slightly green and then yellow within a few days; all traces of the bleeding typically disappear within 1 to 2 weeks. Lacerations, small or large, commonly occur as well and lead to bleeding from the skin.

Damage to the inside of the eye is more serious than damage to the surface. Bleeding into the front chamber of the eye (hyphema or anterior chamber hemorrhage) is serious and requires examination by an ophthalmologist (a medical doctor trained in the medical and surgical treatment of eye disease). Symptoms of bleeding into the front chamber of the eye include reduced vision and light sensitivity. Blood within the front chamber of the eye may cause pressure within the eye to increase (glaucoma). Further bleeding within the eye may occur days after the original injury.

Bleeding can also occur in the back section (posterior segment) of the eye (vitreous hemorrhage), the iris (the colored part of the eye) can be torn, or the lens can be dislocated. Bleeding may also occur in the retina (retinal hemorrhage). The retina can also be torn by injury and may become detached from its underlying surface at the back of the eye (retinal detachment). Initially, retinal detachment may create images of irregular floating shapes or flashes of light and may blur vision, but then vision greatly decreases (see Section 20, Chapter 234). In severe injuries, the thick, fibrous coat of the eyeball (the sclera) can be ruptured.

Treatment

If there is uncertainty about the seriousness of a blunt injury to the eye or if vision is affected, the person should seek immediate medical advice. Generally, an ophthalmologist should evaluate the injury.

During the first 24 to 48 hours, ice packs may help reduce swelling and ease the pain of a black eye. If the skin around the eye or on the eyelid has been cut, stitches may be needed. When possible, stitches near the edge of the eyelids should be placed by an ophthalmologist to ensure that no deformities develop that will affect the way the eyelids close. An injury that affects the tear ducts should be repaired by an ophthalmologist.

A laceration of the eye needs to be evaluated by an ophthalmologist who can determine how deep the cut is and whether surgery is needed to repair the injury. Many injuries involve only the conjunctiva and may not require surgical repair. Cuts involving the deeper layers of the eye (the sclera) or the cornea typically require stitches. Drugs are usually given to ease pain until the cut has healed.

Treatment for bleeding into the anterior chamber of the eye usually involves bed rest with the head of the bed elevated to encourage the blood to settle and eye drops to dilate the pupil and reduce inflammation within the eye. Aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs), which can predispose to bleeding, should be avoided for several weeks.

If there has been a cut that penetrates into the interior of the eye, antibiotics are usually given intravenously first and then occasionally by mouth to prevent infection within the eyeball (endophthalmitis). Eye drops that dilate the pupil can prevent bleeding from the iris and may reduce the sensitivity to light that often accompanies eye injuries. Corticosteroid eye drops are often given to reduce inflammation. A metal shield is often used to protect the eye from further injury. Serious damage may result in a partial or a total loss of vision, even after surgical treatment. Very rarely, after a severe laceration of one eye, the uninjured eye becomes inflamed (sympathetic ophthalmia), which may result in partial loss of vision or even blindness.