Definition

Eyelid trauma is an injury to the eyelid resulting from either intentional or unintentional actions. This injury can hinder the function of the eye as a visual organ. Eyelid trauma encompasses damage to the soft tissue of the eyelid and the surrounding area. It can be categorized into contusion, avulsion, puncture, and laceration traumas. Bruises and abrasions on the eyelids can be managed with topical antibiotics and cold compresses. However, avulsion trauma, punctures, and lacerations of the eyelid necessitate further examination and referral to an ophthalmologist.

Causes

Eyelid trauma can occur from several causes, including:

• Contusion: Damage caused by direct contact with an external object, without tearing the eyelid. This type of trauma can lead to eyelid hematoma, characterized by swelling or blood accumulation under the skin due to ruptured blood vessels. Eyelid hematoma is commonly observed in blunt trauma to the eyelid.
• Laceration: Damage to part or all of the eyelid, occurring from two trauma mechanisms: contact with a sharp, high-speed object that penetrates the skin, causing partial or full-thickness damage, or avulsion injury from blunt trauma.

In children, the most common causes of eyelid trauma include dog bites, falls, and impacts from sharp objects. In adolescents and adults, blunt trauma frequently results from boxing, motor vehicle accidents, and football.

Risk Factors

Eyelid trauma can affect individuals of all ages, including children, adults, and the elderly. In older adults, falls are a common cause of eyelid trauma. Several factors can increase the risk of eyelid trauma, such as:

• Environmental factors
• Activity and work-related factors
• Gender, with men more frequently experiencing eyelid trauma than women, possibly due to differing exposure in daily activities.

Symptoms

Symptoms of eyelid trauma may include:

• Redness
• Swelling
• Damage to surrounding tissues of the eyelids
• Abrasions
• Active bleeding
• Pain extending from the eyelids to the eyeballs

If symptoms worsen or if the trauma is severe, additional symptoms may include:

• Blurred vision
• Blindness

Diagnosis

Diagnosing eyelid trauma involves a comprehensive medical interview to understand the mechanism of the trauma, whether it involved a sharp or blunt object, and to assess visual acuity before and after the injury. It is important to determine whether the visual impairment is gradually progressive or has a sudden onset, and to suspect any foreign objects entering the eyeball.

Physical examinations may include checking visual acuity and visual field, assessing the position of the eyeball and eye muscles, examining the eyelids and the anterior segment of the eye using a flashlight, performing a fluorescein test to detect corneal tears, and using a slit lamp for detailed examination.

The back of the eye is examined with an ophthalmoscope, often after administering medication to dilate the pupil. Comprehensive examination of the eyeball is crucial, even if the wound appears confined to the eyelid. Additionally, intraocular pressure can be measured. If there is suspicion of fractures in the orbital bones, a CT scan may be conducted.

Management

Management of eyelid trauma involves protecting the eyes with a clean cloth and thoroughly washing the wound with running water. For active bleeding, apply pressure to the injury with sterile gauze for 10 minutes to stop the bleeding. If the bleeding persists despite applying pressure, immediate medical attention for wound sutures is necessary. To reduce swelling, apply an ice compress wrapped in a cloth to the affected area for 20 minutes. For severe pain, analgesics such as acetaminophen or ibuprofen can be administered. If bruising occurs due to blood accumulation under the skin, it is generally harmless and it will resolve spontaneously within a few days. In cases of severe trauma, surgical intervention may be required.

Complications

Potential complications of eyelid trauma include scarring, particularly with sharp injuries, infections of the eyeball, blindness, and in severe cases, loss of the eyeball. Eyeball can be removed to prevent damage from spreading to surrounding tissues.

Prevention

To prevent eyelid trauma, it is crucial to avoid giving children objects that pose a risk of penetrating the eye and causing vision loss, such as sharp objects or BB guns. Children should be supervised when playing with animals to prevent bites or scratches. Do not let children be in the vicinity of a workplace with a lot of debris that can affect the eyes, for example nearby someone using a lawn mower. Individuals in environments with a high risk of debris entering the eyes should wear appropriate eye protection.

When to See a Doctor?

Immediate medical attention is necessary if an eyelid injury results in a torn skin requiring stitches, persistent active bleeding, severe eye pain, continuous tearing or blinking, blurred or lost vision in one eye, unequal pupil sizes, bleeding or cloudiness of the cornea, or if the injury involves a high-speed impact or a sharp object. In children, particularly those under three years old, consult a doctor if the child refuses to open their eyes, experiences double vision, has a black eye, or there is bleeding in the white part of the eyeball.

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