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 Dr. Sanjay Dhawan
Trauma
What is it?
What Causes it?
Who are at risk?
What are the symptoms & signs?
How is it diagnosed?
What is the treatment?
What are the surgical options?
 
What is it?
 

Eye trauma refers to damage caused by a direct blow to the eye. The trauma may affect not only the eye, but the surrounding area, including adjacent tissue and bone structure.

There are many different forms of trauma, varying in severity from minor injury to medical emergencies.

What Causes it?
 

When the eye is hit with blunt force, it suddenly compresses and retracts. This can cause blood to collect underneath the hit area, which leads to many of the common symptoms of eye trauma.

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.

Who are at risk?
 

Patients working in chemical factories ,welding and laboratories are more prone to trauma. 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.

What are the symptoms & signs?
 

• Bruising (black eyes)

• Cuts to the eyelid

• Eye redness

• Swelling

• Bleeding between the cornea and iris, known as hyphema

• Retinal detachment

• Blurred or cloudy vision

• Double vision

How is it diagnosed?
 

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 examination should be attempted, and may require a topical anesthetic in order to be tolerable. Many topical agents cause burning upon instillation. Proxymetacaine has been found to have the best tolerance.

The first step is to assess the external condition of the eye and orbit, and check for perforations, hyphema, uveal prolapse, or globe penetration. If the pupil is teardrop-shaped, and the anterior chamber is flat, this is almost always a perforating injury of the cornea or limbal area.

Depending on the medical history 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 burns of the conjunctiva and cornea.

Urgent
An urgent case must be treated within hours. This includes penetrating globe injuries; corneal abrasions or corneal foreign bodies; hyphema (must be referred)' eyelid lacerations that are deep, involve the lid margin or involve the lacrimal canaliculi; radiant energy burns such as arc eye (welder's burn) or snow blindness; or, rarely, traumatic optic neuropathy.

Semi-urgent

Semi-urgent cases must be managed within 1–2 days. They include orbital fractures and subconjunctival hemorrhages.

What is the treatment?
 

In minor cases of trauma, such as a black eye from a sports injury, applying cold to the affected area can help bring swelling down, and allow the affected area to heal faster.

However, even in cases where trauma seems minor, every eye injury should be given medical attention.

Irrigation
The first line of management for chemical injuries is usually copious irrigation of the eye with an isotonic saline or sterile water. In the cases of chemical burns, one should not try to buffer the solution, but instead dilute 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 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.

What are the surgical options?
 

Surgery depends upon the ocular injury.

What are the outcomes?
 

The outcomes depends upon the the type of ocular trauma ,it may vary from person to person and are usually satisfactory.

What are the complications?
 

Multiple complications are known to occur following eye injury: corneal scarring, hyphema, iridodialysis, post-traumatic glaucoma, uveitis , cataract, vitreous hemorrhage and retinal detachment. The complications risk is high with retinal tears, penetrating injuries and severe blunt trauma.

What is the time course?
 

Regular follow ups are required as advised by ophthalmologists.

What is the expense?
 

The expense depends upon the grades of treatment.

 
Author: Dr. Sanjay Dhawan
Last Updated on: 1 March, 2014
   

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