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KEY POINTS
Mechanical trauma to the eye is divided into open globe injury, where the sclera and/or cornea (eyewall) have a full-thickness wound, and closed globe injury, where these structures do not have a full thickness-injury.
The six extraocular muscles are attached directly to the sclera, which is covered by the thin clear conjunctiva, which itself terminates at the cornea.
In the patient’s history, posttrauma floaters and a visual field defect are highly suggestive of a retinal detachment.
When trying to measure vision between 1/200 and 20/20, the patient should be wearing his or her eyeglasses.
The pupil may be peaked if the iris is sealing (plugging) a corneal or anterior scleral laceration.
Computed tomography imaging is used to evaluate orbital fractures, orbital foreign bodies, and intraocular foreign bodies.
After the application of appropriate medication, corneal abrasions heal faster without patching.
Prior to consultation with an ophthalmologist, routine treatment for a hyphema can be initiated with topical steroid eye drops four times a day and a topical cycloplegic agent.
Intraocular foreign bodies are associated with an increased incidence of endophthalmitis that results in poorer visual outcomes after penetrating injury.
One of the signs of an orbital floor fracture is decreased skin sensation on the cheek of the affected side.
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EPIDEMIOLOGY OF EYE TRAUMA
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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 more than 39,000 patients treated for major trauma over 15 years 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
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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 due to sharp objects (54.1%), followed by blunt objects (34.4%); chemical injuries accounted for 11.5% of ocular injuries.3
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EYE TRAUMA: TERMINOLOGY AND CLASSIFICATION
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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 department/urgent care setting. Chemical injury (alkali and acid burns) is not uncommon, and its management will be discussed in detail because immediate intervention by first responders and emergency department physicians can be sight-saving.
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