Chapter 20: Eye

EPIDEMIOLOGY OF EYE TRAUMA

Worldwide 1.6 million people are estimated to be blind from ocular trauma and another 19 million people suffer from severely impaired vision in one eye due to trauma.¹ Published literature from England looking at 15 years of more than 39,000 patients treated for major trauma found that 2.3% of patients had associated ocular injuries. Given that the eyes represent only 0.27% of the total body area, it is a curious phenomenon that the eyes are affected so often. In this series, the most common injuries involved the cornea, optic nerve, conjunctiva, and sclera.²

Men are reported to be four times more likely to suffer from ocular trauma compared to women and in the same series from England, 75.1% of major trauma patients with ocular injuries were men. While ocular trauma most commonly results from motor vehicle accidents, workplace injuries, and recreational injuries are also very commonly seen. Most injuries were resulting from sharp objects (54.1%), followed by blunt objects (34.4%), and chemical injuries accounted for 11.5% of ocular injuries.³

EYE TRAUMA TERMINOLOGY AND CLASSIFICATION

Eye trauma is divided first by etiology into mechanical, chemical, thermal, and electric. Thermal (eg, corneal burn from curling iron) and electric (eg, lightning) eye traumas are very uncommon and treatment of complications will be by an ophthalmologist in an outpatient setting after discharge from the emergency room/urgent care setting. Chemical injury (alkali and acid burns) is not uncommon and its management will be discussed in detail as immediate intervention by first responders and emergency room physicians can be sight-saving.

Mechanical eye trauma is the most common form of eye injury. It is divided into open globe injury, where the sclera and/or cornea (eyewall) have a full-thickness wound, and closed globe injury where the eyewall does not have a full-thickness wound (Fig. 20-1).^4,5,6 Closed globe injuries are further subdivided into contusion injuries, lamellar laceration (ie, partial thickness laceration), and superficial foreign body (ie, foreign body lodged on cornea, conjunctiva, or under the conjunctiva but without full-thickness wound of the eyewall).⁶ Open globe injuries are further divided into ruptured globes and globe lacerations.^4,5 Ruptured globes result from blunt trauma, due to an extreme elevation of intraocular pressure on the moment of impact causing a rupture of the eyewall at the weakest site of the globe (force from inside out), usually away from the site of impact and frequently with significant herniation of intraocular contents.^4,5,6 Globe lacerations result from sharp trauma (usually) due to the direct impact on the eyewall (force from outside inwards).^4,5 Perforating injury is a specific type of globe laceration in which the projectile or sharp object has caused an entry as well as an exit full-thickness eyewall wound.^4,5 In a penetrating injury only a single ...