Trauma
To The Eye (Eye Injuries)Introduction: Any traumatic
injury to the eye needs to be taken seriously. Here are some statistics of trauma
to the eyes (ocular trauma). Depending on the injury it could be
very superficial like a laceration to the upper eye lid, which only needs a few
sutures in the hospital Emergency Room. An eye lid laceration that involves
the margin of the eye-lid needs a complicated plastic surgical repair utilizing
an operating microscope that should be done by an eye surgeon. The eye injury
could involve a metal foreign body that perforated the cornea and entered deep
into the eye ("intraoccular foreign body"), which is an acute ophthalmic
emergency where an eye surgeon has to explore the eye and carefully check that
the anatomy of the lens, the vitreous and the retina have not been disrupted.
There
can also be a blunt eye injury (e.g. airbag
injury) or a burn injury, which all need to be carefully evaluated.Prevention
of eye injuries is of the utmost importance. Signs
and symptoms: Symptoms vary depending on what the underlying mechanism
of eye injury was. With a chemical injury there would be a burning pain, redness
and swelling. With a small abrasion of the cornea from a contact lens injury there
would be a foreign body feeling, pain and light sensitivity. Here are many
more symptoms of eye injuries listed and the underlying corresponding
injuries. Diagnostic tests: Ultrasound
biomicroscopy is a newer tool that can be utilized to examine traumatic
damage to structures of the eye. Here is an image of the normal
eye anatomy using this technology. Otherwise the standard
diagnostic tests for eye diseases are done. Direct physical examination
amplified by direct ophthalmoscopy and slit
lamp examination helps the physician to evaluate most eye injuries.
Intraoccular pressure is tested. Ophthalmic
echography is useful for the detection of any unusual intraoccular
mass. To check for the integrity of the retinal blood vessels, a dye can be injected
intravenously and subsequently pictures of the fluorescein
stained blood vessels can be taken. For deeper injuries CT
scans and MRI scans may be required. As
an example, here is a link showing a fracture
at the bottom of the eye cavity . For the untrained observer this
needs a brief explanation: We are looking through the head of an injured person
from the back to the front. We see the brain cavity on top and the left
and right eye cavities underneath. The sinus cavities are underneath the eye cavities
with the nasal cavity between and the mouth cavity underneath in the center. The
left eye cavity has a fracture on the bottom where orbital fat tissue has herniated
into the sinus cavity underneath. It is clear from a comparison between the right
and left sinus cavities that in the left there is blood (gray color) on the bottom
and air (black) on top. In the corresponding right sinus cavity the space is empty
(only black colored air). This is called a "blowout fracture" of the
left eye cavity and would be typical for a fist fight or when a shrapnel from
a gunshot wound had entered the eye cavity.
Treatment:
The
first seconds and minutes count most after an eye injury. If the eye was injured
from a lie (=alkaline chemical compound) the eye needs to be washed for at least
5 minutes (better up to 15 or 20 minutes) with tap water. One way to do this is
to simply fill a sink with water and open and close the eyes many times to dilute
the chemical and flush it out at the same time. Have the patient assessed by an ophthalmologist on an emergency basis.
Eye lid lacerations:
If the margin of an eye lid is lacerated, an eye surgeon needs to be consulted
for an exact repair with the help of the operating microscope. Metal
foreign body in the cornea: Under an anesthetic the foreign body
is removed and any rust spot (from iron or steel piece) has to be carefully removed. Corneal
ulcer: If the person wears a contact lens, this has to be removed
and the eye is treated with Polytrim or erythromycin ointment and followed every
day by the eye specialist until healed. There is a great danger that the cornea
perforates, if his is not carefully followed up. Penetrating
Wounds of the Eye: Some of these injuries can be very ugly.
Here is a text that deals with this topic in more
detail. Burns of the eye: It has
to be identified what has been burnt. If there was exposure to extreme heat, the
eye lids will have suffered burns, but the cornea can also suffer some degree
of burning. These injuries are complicated and need close supervision by an eye
specialist, often with hospitalization for several days. Various
sports injuries: In this link to common
sports injuries it is described what tests and procedures need to
be done to remedy the situation as much as it can be remedied.
|
