Ocular Trauma

Ocular traumas occur very frequently. The severity of the trauma varies and only an intricate eye exam can determine which part of the eyes have been affected. Even if there is no pain, it does not necessarily mean that there is not a problem. It is imperative that a proper eye examination is carried out.

Ocular Contusions

This is a shock to the eye without causing a wound. They occur mostly during sport following direct impact on the eye and can cause serious injury. Ball games such as baseball, squash, tennis and hockey all carry a high risk of obtaining ocular contusion.

More minor injuries are caused by a slight blow (such as being poked by a finger). The examination reveals a normal anterior segment where the pupil responds well to light. There is frequently a mild subconjunctival haemorrhage, which will eventually disappear. The intraocular pressure and the fundus are normal. With these less serious cases, a simple treatment is usually prescribed (anti-inflammatory and / or antiseptic).

The eye examination should always be carried out with a great deal of caution, especially if it involves an eyelid edema, which can hide a penetrating puncture of the globe.

The most serious injuries are caused by violent traumas from small balls (tennis or squash), golf clubs, bullets, or pellets from a gun. In such circumstances, the patient is often in a lot of pain which is sometimes accompanied by nausea and / or vomiting. The patient sometimes has difficulty in standing, look pale and it is often difficult to examine.

The eye often becomes red with blood in the anterior chamber, known as hyphema. A comprehensive eye assessment should be performed so as not to miss any hidden injuries (rupture of the sclera, a small perforation). The intraocular pressure should also be measured. This requires hospitalization.

The infiltration of blood into the cornea is a serious complication. It is characterized by an almost complete loss of vision. It occurs quickly after the initial trauma. Recovery of visual acuity after such a trauma varies considerably from patient to patient. Medical treatment of secondary hypertension is important. Surgery is sometimes necessary (washing, removal of clots, and even keratoplasty).

Retinal lesions are often found at the fundus of the eye and thus the prognosis is made after examining this. A vitreous haemorrhage may make the examination of the retina more complicated. The examination includes an ultrasound if the retina is not visible and possibly an angiography to detect macular edema. Other examinations provide remarkable follow-up care such as OCT (Optical Coherence Tomography).

Traumatic cataract can develop in varying delays. It will require medical attention.

Non perforating wounds

Ophthalmologists come across foreign bodies in the cornea on a daily basis ; they usually come from using a grinding wheel without wearing protective eye wear. It can be very painful and the patient is unable to sleep if it is not removed. They rust quickly. It is therefore necessary to remove it as soon as possible, as rust irritates the anterior segment and may cause localised swelling of the cornea. The removal of the piece of iron is facilitated as it rusts forming easily removed agglomerate.

After the object has been removed, antiseptic treatment should be administered for a few days (sometimes in conjunction with an ocular dressing). Other non-metallic fragments can be removed from the cornea (vegetable matter, hair etc.)

Ulcers from corneal traumas occur when there is an unhealed piercing but no foreign body. The most common case of this involves a mother accidentally scratching her babies’ eye with her fingernail.

Sensitivity to light and headaches make the examination difficult. (In this case, the ophthalmologist puts a drop of anaesthetic cornea into the eye to make the examination easier).

Puncture wounds

These are caused by projected corrosive chemical products, sparks from machinery or exposure to harmful light rays such as laser beams. Burns represent one in every ten eye accidents. They can cause serious lesions if sufficient eye protection is not used.

Injuries where the eye is perforated can be very serious. Patients must be treated in a specialist ophthalmology ward.

If the perforation occurred whilst using a hammer and chisel, strimmer, or explosion then it is very serious.

The pain a patient experiences does not necessarily correlate to the severity of the trauma, for instance being cut by a nail, although not particularly difficult to treat, can often hurt a great deal, where as a perforation caused by a wire is much more severe even though the patient does not experience a lot of pain.

The examination reveals a deformed pupil and a prolapsed iris that can be seen through the cornea, if not through the vitreous or retina. Corneal fluorescein is used to detect foreign bodies and identify superficial scratches on the cornea. Eye traumas are often difficult to diagnose and neglected when a patient arrives a hospital with many injuries which may require more immediate attention.

It is treated with antibiotic eye drops whilst protecting the eye with an eye patch for at least 24 hours.

The complete and detailed examination must also look for wounds located behind the cornea, as sometimes the anterior segment of the eye will appear normal. This means that a scleral wound can be detected with the emergence of vitreous through the wound.

In most cases the treatment requires surgery. The patient has to fast prior to the anaesthesia. They also need to be vaccinated against tetanus.

Puncture wounds are usually caused by foreign bodies that get into the eye. These are pieces of (usually) metal that get into the cornea and get lodged inside the eye or even in orbit. It is sometimes possible to see the foreign body stuck in the retina directly by examining the fundus. The lens becomes opaque. It will therefore be necessary to operate on the patient to improve their vision.

An x-ray should be performed in order to visualize any intraocular foreign bodies. If the intraocular foreign body is not diagnosed, then various complications can arise, including Siderosis (caused by a deposition of iron in the eye) or Chalcosis (caused by a deposition of copper in the eye), resulting in the loss of the eye.

Associated Lesions

Sometimes ocular lesions are associated with eyelid wounds or a fracture of inner eye socket.

Ocular burns

Eye burns may involve the eyelids, conjunctiva or cornea.

They are caused by corrosive chemicals, sparks from welding or exposure to harmful light rays such as laser beams. Burns are responsible for one in every ten eye injuries. They can cause serious damage if no eye protection is being worn.

The majority of chemical eye injuries are cause by acids (e.g. explosion of a car battery) : in these cases, the prognosis is good, because the acid only alters the superficial surface layers of the cornea. Burns caused by alkali (e.g. Ammonia) are less frequent but much more serious.

In case of chemicals getting into the eye, it is recommended to immediately flush the eye with clean water after having administering anaesthetic eye drops. Lay the person flat and continually pour water on the eye for at least 15 minutes. The eye can then be examined with fluorescein to reveal any corneal ulcers. In the case of an ulcer, antibiotics are prescribed, and the patient is advised to where an eye patch. In this case, the patient must immediately be referred to an ophthalmologist because they will need to be treated with steroids, tetracycline eye drops and vitamin C.

The sun is dangerous for your eyes

Ultraviolet radiation from the sun (UVA/UVB) can also damage your eyes. Exposure to intense sun rays for too long can lead to photokeratitis. In the long term a crystalline opacification (cataract) can occur. Looking at a solar eclipse even for a few minutes without proper protection can result in damage to the macula.

Protect your eyes at all times

Eyes are the most easily damaged organs in the human body

  • Always wear protective glasses when doing DIY
  • Do not allow children to play with BB guns, arrows or rifles
  • Never touch an eye that has been injured
  • Consult an ophthalmologist as soon as possible
  • Don’t forget that we only have 2 eyes