Eye injury
Encyclopedia
Physiology
Physiology is the science of the function of living systems. This includes how organisms, organ systems, organs, cells, and bio-molecules carry out the chemical or physical functions that exist in a living system. The highest honor awarded in physiology is the Nobel Prize in Physiology or...
or chemical injuries of the eye
Human eye
The human eye is an organ which reacts to light for several purposes. As a conscious sense organ, the eye allows vision. Rod and cone cells in the retina allow conscious light perception and vision including color differentiation and the perception of depth...
can be a serious threat to vision
Visual perception
Visual perception is the ability to interpret information and surroundings from the effects of visible light reaching the eye. The resulting perception is also known as eyesight, sight, or vision...
if not treated appropriately and in a timely fashion. The most obvious presentation of ocular (eye) injuries is red
Red
Red is any of a number of similar colors evoked by light consisting predominantly of the longest wavelengths of light discernible by the human eye, in the wavelength range of roughly 630–740 nm. Longer wavelengths than this are called infrared , and cannot be seen by the naked eye...
ness and pain
Pain
Pain is an unpleasant sensation often caused by intense or damaging stimuli such as stubbing a toe, burning a finger, putting iodine on a cut, and bumping the "funny bone."...
of the affected eyes. This is not, however, universally true, as tiny metal
Metal
A metal , is an element, compound, or alloy that is a good conductor of both electricity and heat. Metals are usually malleable and shiny, that is they reflect most of incident light...
lic projectile
Projectile
A projectile is any object projected into space by the exertion of a force. Although a thrown baseball is technically a projectile too, the term more commonly refers to a weapon....
s may cause neither symptom. Tiny metallic projectiles should be suspected when a patient reports metal on metal contact, such as with hammering a metal surface. Intraocular foreign bodies do not cause pain because of the lack of nerve endings in the vitreous humour
Vitreous humour
The vitreous humour or vitreous humor is the clear gel that fills the space between the lens and the retina of the eyeball of humans and other vertebrates...
and retina
Retina
The vertebrate retina is a light-sensitive tissue lining the inner surface of the eye. The optics of the eye create an image of the visual world on the retina, which serves much the same function as the film in a camera. Light striking the retina initiates a cascade of chemical and electrical...
that can transmit pain sensations. As such, general or emergency room doctor
Physician
A physician is a health care provider who practices the profession of medicine, which is concerned with promoting, maintaining or restoring human health through the study, diagnosis, and treatment of disease, injury and other physical and mental impairments...
s should refer cases involving the posterior segment
Posterior segment
The posterior segment is the back two-thirds of the eye that includes the anterior hyaloid membrane and all of the optical structures behind it: the vitreous humor, retina, choroid, and optic nerve....
of the eye or intraocular foreign bodies to an ophthalmologist. Ideally, ointment would not be used when referring to an ophthalmologist, since it diminishes the ability to carry out a thorough eye examination
Eye examination
An eye examination is a battery of tests performed by an ophthalmologist, optometrist, or orthoptist assessing vision and ability to focus on and discern objects, as well as other tests and examinations pertaining to the eyes....
.
Causes
Flicking sand, flying pieces of wood, metal, glass, stone and other material are notorious for causing much of the eye trauma. Sporting balls such as cricket ball, lawn tennis ball, squash ball), shuttle cock (from Badminton) and other high speed flying objects can strike the eye. The eye is also succeptible to blunt trauma in a fistfight. The games of young children such as bow-and-arrows, bb guns and firecrackers can lead to eye trauma. Road traffic accidents (RTAs) with head and facial trauma may also have an eye injury - these are usually severe in nature with multiple lacerations, shards of glasses embedded in tissues, orbital fractures, severe hematoma and penetrating open-globe injuries with prolapse of eye contents. Other causes of intraocular trauma may arise from workplace tools or even common household implements.Effects of eye injury
- Closed globe injury or Non-penetrating trauma: The eye globe is intact, but the seven rings of the eye have been classically described as affected by blunt trauma.
- Penetrating trauma: The globe integrity is disrupted by a full-thickness entry wound and may be associated with prolapse of the internal contents of the eye.
- Perforating trauma: The globe integrity is disrupted in two places due to an entrance and exit wound (through and through injury). This is a quite severe type of eye injury.
- Blowout fracture of the orbit is caused by blunt trauma, classically described for fist or ball injury, leading to fracture of the floor or medial wall of the orbit due to sudden increased pressure on the orbital contents.
Epidemiology
A recent study estimated that from 2002-2003 there were 27,152 injuries in the United States related to the wearing of eyeglasses. The same study concluded that sports-related injuries due to eyeglasses wear were more common in those under the age of 18 and that fall-related injuries due to eyeglasses wear were more common in those aged 65 or more. Although eyeglasses-related injuries do occur, prescription eyeglasses and non-prescription sunglassesSunglasses
Sunglasses or sun glasses are a form of protective eyewear designed primarily to prevent bright sunlight and high-energy visible light from damaging or discomforting the eyes. They can sometimes also function as a visual aid, as variously termed spectacles or glasses exist, featuring lenses that...
have been found to "offer measurable protection which results in a lower incidence of severe eye injuries to those wearing [them]".
Investigation
The goal of investigation is the assessment of the severity of the ocular injury with an eye to implementing a management plan as soon as is required. The usual eye examinationEye examination
An eye examination is a battery of tests performed by an ophthalmologist, optometrist, or orthoptist assessing vision and ability to focus on and discern objects, as well as other tests and examinations pertaining to the eyes....
should be attempted, and may require a topical anesthetic
Topical anesthetic
A topical anesthetic is a local anesthetic that is used to numb the surface of a body part. They can be used to numb any area of the skin as well as the front of the eyeball, the inside of the nose, ear or throat, the anus and the genital area. Topical anesthetics are available in creams,...
in order to be tolerable. Many topical agents cause burning upon instillation. Proxymetacaine
Proxymetacaine
Proxymetacaine or proparacaine is a topical anesthetic drug of the aminoester group.-Indications and usage:Proxymetacaine hydrochloride ophthalmic solution is indicated for procedures such as tonometry, gonioscopy, removal of foreign bodies, or other similar procedures requiring topical...
has been found to have the best tolerance.
The first step is to assess the external condition of the eye and orbit
Orbit (anatomy)
In anatomy, the orbit is the cavity or socket of the skull in which the eye and its appendages are situated. "Orbit" can refer to the bony socket, or it can also be used to imply the contents...
, and check for perforation
Perforation
A perforation is a small hole in a thin material or web. There is usually more than one perforation in an organized fashion, where all of the holes are called a perforation...
s, hyphema
Hyphema
Hyphema is blood in the front chamber of the eye. It may appear as a reddish tinge, or it may appear as a small pool of blood at the bottom of the iris or in the cornea.-Causes:...
, uveal prolapse, or globe penetration. If the pupil
Pupil
The pupil is a hole located in the center of the iris of the eye that allows light to enter the retina. It appears black because most of the light entering the pupil is absorbed by the tissues inside the eye. In humans the pupil is round, but other species, such as some cats, have slit pupils. In...
is teardrop-shaped, and the anterior chamber is flat, this is almost always a perforating injury of the cornea
Cornea
The cornea is the transparent front part of the eye that covers the iris, pupil, and anterior chamber. Together with the lens, the cornea refracts light, with the cornea accounting for approximately two-thirds of the eye's total optical power. In humans, the refractive power of the cornea is...
or limbal area.
Depending on the medical history
Medical history
The medical history or anamnesis of a patient is information gained by a physician by asking specific questions, either of the patient or of other people who know the person and can give suitable information , with the aim of obtaining information useful in formulating a diagnosis and providing...
and preliminary examination, the primary care physician should designate the eye injury as a true emergency, urgent or semi-urgent.
Emergency
An emergency must be treated within minutes. This would include chemical burnChemical burn
A chemical burn occurs when living tissue is exposed to a corrosive substance such as a strong acid or base. Chemical burns follow standard burn classification and may cause extensive tissue damage. The main types of irritant and/or corrosive products are: acids, bases, oxidizers, solvents,...
s of the conjunctiva
Conjunctiva
The conjunctiva covers the sclera and lines the inside of the eyelids. It is composed of rare stratified columnar epithelium.-Function:...
and cornea
Cornea
The cornea is the transparent front part of the eye that covers the iris, pupil, and anterior chamber. Together with the lens, the cornea refracts light, with the cornea accounting for approximately two-thirds of the eye's total optical power. In humans, the refractive power of the cornea is...
.
Urgent
An urgent case must be treated within hours. This includes penetrating globe injuries; corneal abrasionCorneal abrasion
Corneal abrasion is a medical condition involving the loss of the surface epithelial layer of the eye's cornea.-Symptoms and signs:Symptoms of corneal abrasion include pain, photophobia, a foreign-body sensation, excessive squinting, and a reflex production of tears...
s or corneal foreign bodies; hyphema (must be referred)' eyelid lacerations that are deep, involve the lid margin or involve the lacrimal canaliculi
Lacrimal canaliculi
The lacrimal canaliculi, also known as the lacrimal canals or lacrimal ducts, are the small channels in each eyelid that commence at minute orifices, termed puncta lacrimalia, on the summits of the papillae lacrimales, seen on the margins of the lids at the lateral extremity of the lacus...
; radiant energy burns such as arc eye (welder's burn) or snow blindness
Snow blindness
Photokeratitis or ultraviolet keratitis is a painful eye condition caused by exposure of insufficiently protected eyes to the ultraviolet rays from either natural or artificial sources. Photokeratitis is akin to a sunburn of the cornea and conjunctiva, and is not usually noticed until several...
; or, rarely, traumatic optic neuropathy
Optic neuropathy
The optic nerve contains axons of nerve cells that emerge from the retina, leave the eye at the optic disc, and go to the visual cortex where input from the eye is processed into vision. There are 1.2 million optic nerve fibers that derive from the retinal ganglion cells of the inner retina. Optic...
.
Semi-urgent
Semi-urgent cases must be managed within 1–2 days. They include orbital fractures and subconjunctival hemorrhageSubconjunctival hemorrhage
thumb|right|250px| A stress induced subconjunctival hemorrhage in the left eye one week after hemorrhaging. Same hemorrhage four weeks after hemorrhaging. Some of the blood in the [[sclera]] has turned yellow, like a bruise....
s.
Irrigation
The first line of management for chemical injuries is usually copious irrigationIrrigation
Irrigation may be defined as the science of artificial application of water to the land or soil. It is used to assist in the growing of agricultural crops, maintenance of landscapes, and revegetation of disturbed soils in dry areas and during periods of inadequate rainfall...
of the eye with an isotonic
Isotonic
The term isotonic may refer to;*Isotonic for the term associated with muscle contraction*An isotone in nuclear physics*Sports drinks are sometimes designed in an isotonic way to assist athletes rehydrate while balancing electrolytes...
saline
Saline (medicine)
In medicine, saline is a general term referring to a sterile solution of sodium chloride in water but is only sterile when it is to be placed intravenously, otherwise, a saline solution is a salt water solution...
or sterile
Sterilization (microbiology)
Sterilization is a term referring to any process that eliminates or kills all forms of microbial life, including transmissible agents present on a surface, contained in a fluid, in medication, or in a compound such as biological culture media...
water
Water
Water is a chemical substance with the chemical formula H2O. A water molecule contains one oxygen and two hydrogen atoms connected by covalent bonds. Water is a liquid at ambient conditions, but it often co-exists on Earth with its solid state, ice, and gaseous state . Water also exists in a...
. In the cases of chemical burns, one should not try to buffer
Buffering agent
A buffering agent is a weak acid or base used to maintain the acidity of a solution at a chosen value. The function of a buffering agent is to prevent a rapid change in pH when acids or bases are added to the solution. Buffering agents have variable properties—some are more soluble than others;...
the solution, but instead dilute
Dilution
Dilution may refer to:* Reducing the concentration of a chemical* Serial dilution, a common way of going about this reduction of concentration* Homeopathic dilution* Dilution , an equation to calculate the rate a gas dilutes...
it with copious flushing.
Patching
Depending on the type of ocular injury, either a pressure patch or shield patch should be applied. In most cases, such as those of corneal abrasion or the like, a pressure patch should be applied that ensures some tension is applied to the eye, and that the patient cannot open his or her eye under the patch. In cases of globe penetration, pressure patches should never be applied, and instead a shield patch should be applied that protects the eye without applying any pressure. If a shield patch is applied to one eye, the other eye should be also be patched due to eye movement. If the uninjured eye moves, the injured eye will also move involuntarily possibly causing more damage.Suturing
In cases of eyelid laceration, sutures may be a part of appropriate management by the primary care physician so long as the laceration does not threaten the canaliculi, is not deep, and does not affect the lid margins.Complications
Multiple complications are known to occur following eye injury: corneal scarring, hyphemaHyphema
Hyphema is blood in the front chamber of the eye. It may appear as a reddish tinge, or it may appear as a small pool of blood at the bottom of the iris or in the cornea.-Causes:...
, iridodialysis
Iridodialysis
Iridodialysis, sometimes known as a coredialysis, is a localized separation or tearing away of the iris from its attachment to the ciliary body.-Causes:...
, post-traumatic glaucoma
Glaucoma
Glaucoma is an eye disorder in which the optic nerve suffers damage, permanently damaging vision in the affected eye and progressing to complete blindness if untreated. It is often, but not always, associated with increased pressure of the fluid in the eye...
, uveitis
Uveitis
Uveitis specifically refers to inflammation of the middle layer of the eye, termed the "uvea" but in common usage may refer to any inflammatory process involving the interior of the eye....
cataract
Cataract
A cataract is a clouding that develops in the crystalline lens of the eye or in its envelope, varying in degree from slight to complete opacity and obstructing the passage of light...
, vitreous hemorrhage
Vitreous Hemorrhage
Vitreous Hemorrhage is the extravasation of blood into the areas in and around the vitreous humor of the eye. The vitreous humor is the clear gel that fills the space between the lens and the retina of the eye...
and retinal detachment
Retinal detachment
Retinal detachment is a disorder of the eye in which the retina peels away from its underlying layer of support tissue. Initial detachment may be localized, but without rapid treatment the entire retina may detach, leading to vision loss and blindness. It is a medical emergency.The retina is a...
. The complications risk is high with retinal tears, penetrating injuries and severe blunt trauma.
See also
- List of eye diseases and disorders
- Facial traumaFacial traumaFacial trauma, also called maxillofacial trauma, is any physical trauma to the face. Facial trauma can involve soft tissue injuries such as burns, lacerations and bruises, or fractures of the facial bones such as nasal fractures and fractures of the jaw, as well as trauma such as eye injuries...
- Black eyeBlack eyeA black eye , or or 'shiner', is bruising around the eye commonly due to an injury to the face rather than eye injury. The name is given due to the color of bruising. The so-called black eye is caused by bleeding beneath the skin and around the eye...
- United States Eye Injury RegistryUnited States Eye Injury RegistryThe United States Eye Injury Registry is an American national database of eye injuries....
, which compiles statistics regarding eye injuries in the United States.