Definition

Eye trauma refers to damage to the tissues of the eyeball, eyelid, optic nerve, or eye cavity caused by a sharp or blunt object impacting the eye with varying degrees of force. It is considered a medical emergency, as even mild injuries can lead to blindness or loss of the eye.

Causes

The causes of eye trauma are diverse and include chemical exposure, bleeding, corneal abrasions, iritis, hyphema, orbital fractures, conjunctival lacerations, corneal and scleral lacerations, orbital, corneal or intraocular foreign bodies, and ultraviolet keratitis from solar retinopathy. Generally, ocular trauma can be categorized into mechanical trauma (blunt and sharp), physical trauma (infrared radiation, ultraviolet light, X-rays), and chemical trauma (acid-base exposure)

Risk Factors

Several risk factors can increase the likelihood of eye trauma, such as age. Children are at a higher risk of eye trauma compared to adults. Environmental factors include living in areas with high risks of accidents, or engaging in certain activities or jobs that expose the eyes to potential hazards. Other factors are health conditions. Diseases that cause excessive coughing or straining, leading to spontaneous bleeding in the eyes, especially in the subconjunctival area.

Symptoms

The symptoms of eye trauma vary depending on the cause:

1. Chemical Burns

 Persistent pain or burning in the eyes, eye redness, and swollen eyelids.

2. Bleeding

 In ocular trauma cases with bleeding, it is generally painless and does not affect vision. Bleeding occurs in the sclera due to broken surface blood vessels. The eye redness can be alarming, spontaneous bleeding can occur even if it is not accompanied by known trauma. Examples of non-traumatic causes are coughing or excessive straining. If bleeding is not accompanied by other traumatic signs, it usually resolves in 4 to 10 days without treatment.

3. Corneal Abrasions

Corneal abrasion is also one of the causes of eye trauma. Symptoms include pain, a sensation like there is something in the eye, tearing eyes and sensitivity to light. In the case of iritis, which is inflammation of the iris of the eye, it causes symptoms of pain and increased sensitivity to light. Often described as a deep pain in the eye and its surroundings. Sometimes there is a tear in the eye.

4. Hyphema

Blood collects in the anterior chamber of the eye, causing pain and blurred vision.

5. Orbital Fractures

Symptoms include pain with eye movement, double vision that improves after closing one eye, eyelids swelling, and bruising around the eyes. Black eyes due to blood accumulation in the eyelids can occur. Healing process can take weeks until the symptoms are fully gone.

6. Laceration 

• Conjunctival Laceration: Pain, redness, and a foreign body object sensation in the eye.
• Corneal and Scleral Lacerations: Vision loss and eye pain.

7. Foreign Objects in the eye

• Corneal Foreign Bodies: Foreign body sensation, blurred vision, sensitivity to light, and the foreign objects stuck in the cornea can be visible. There could be rust stains if the object is metal.
• Orbital Foreign Bodies: Symptoms include vision loss, eye pain, and double vision, appearing hours to days after injury.

8. Sunlight

• Ultraviolet Keratitis: Sore eyes, sensitivity to light, eye redness, and a sensation of foreign body objects. Symptoms generally appear hours after UV rays exposure.
• Solar Retinopathy: Vision loss and the appearance of one blurry spot.

9.Blunt and Sharp Force Trauma

• Blunt Trauma: Conjunctival edema, resulting in mucous layer damage and swelling. In severe conjunctival edema, symptoms can include incomplete eyelid closure.
• Sharp Force Trauma: Signs include decreased visual acuity, low intraocular pressure, shallow eye chambers, altered pupil shape and location, visible tears in the cornea or sclera, and tissue prolapse

Diagnosis

The diagnosis of ocular trauma involves a comprehensive interview that includes assessing visual acuity before and immediately following the injury. It is essential to determine whether the visual impairment has a gradual progression or a sudden onset, with a high index of suspicion for an intraocular foreign body. Subsequent physical eye examinations should include evaluations of visual acuity, visual field, eyeball and eye muscle position, eyelid inspection, anterior eye examination using a flashlight, and a fluorescein test to detect corneal tears. Further examination using a slit lamp is recommended. The posterior segment of the eye should be assessed with an ophthalmoscope, facilitated by pupil dilation. Additionally, intraocular pressure should be measured. In cases where an orbital fracture is suspected, a CT scan is indicated.

Management

Management of eye trauma necessitates immediate protection of the eye with a clean cloth, followed by thorough irrigation of the wound with running water. In instances of active bleeding, apply pressure with sterile gauze for 10 minutes to achieve hemostasis. For swelling, an ice compress wrapped in cloth can be applied gently to the swollen area for 20 minutes. Analgesics such as paracetamol or ibuprofen may be administered if pain is severe. Ecchymosis or "black eye" caused by blood accumulation under the skin is generally benign, resolving spontaneously within a few days without special treatment. Subconjunctival hemorrhage, or bleeding in the sclera, also typically resolves without intervention as the blood is reabsorbed by the body.

Complications

Potential complications from eye trauma include scar formation, particularly in penetrating injuries, ocular infections, blindness, and in severe cases, loss of the eyeball to prevent the spread of damage to surrounding tissues.

Prevention

Penetrative injuries to the eyeball often result in vision loss. It is crucial to prevent children from accessing objects that pose a risk of eye injury, such as sharp implements or air guns (BB guns), and to keep them away from activities that generate debris, like lawn mowing. Individuals in high-risk environments should consistently use appropriate eye protection.

When to see a doctor?

Immediate medical attention is warranted if the injury involves the eyelid or eyeball, especially if it results in a skin laceration requiring sutures, severe eye pain, persistent tearing or blinking, blurred or lost vision in one eye, anisocoria, blood or cloudiness behind the cornea, or a history of high-velocity impact or penetration by a sharp object. For children under three years old, prompt consultation is necessary if the child refuses to open their eyes, exhibits diplopia, has a black eye, or shows bleeding in the sclera.

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