Definition

Ocular trauma can be categorized into two types, trauma caused by blunt force and sharp force. These classifications are based on the nature of the object causing the injury. Ocular trauma can affect individuals of any age, gender, or race, though risk factors and common causes vary by region, environment, and socioeconomic status. Typically, the trauma affects only one eye, with symptoms and complications localized to the injured eye.

Causes

Blunt ocular trauma can result from impacts caused by hands, balls, tables, and similar objects to the eyes. Sharp force trauma, on the other hand, can be caused by knives, scissors, nails, screws, bullets, and other penetrating items. The severity of the injury depends on factors such as the object’s bluntness or sharpness, impact speed, point of contact, and the material of the impacting object. Most ocular traumas occur at home or in the workplace.

In the United States, common causes of eye trauma vary by age group. Adults often sustain eye injuries from rocks, punches, baseballs, wood, and fishing equipment. Teenagers frequently experience ocular trauma caused by toy bullets and paintballs, while falls and slips are common causes in the elderly, exacerbated by the structural weakening of the eyeball due to aging.

Risk Factor

Men are more likely than women to experience ocular trauma, largely due to occupational hazards, situations, and objects associated with increased risk. The peak incidence of ocular trauma occurs between ages 30 and 40, often due to non-compliance with personal protective equipment while engaging in activities such as baseball, basketball, or home electrical repairs. Substance abuse, including alcohol and marijuana intoxication, is another significant risk factor.

Symptoms

The symptoms resulting from ocular trauma vary depending on the nature of the object and the force of impact. Sharp trauma typically presents with eye pain and double vision. Small objects causing the trauma may cause a sensation of a foreign body in the eye. If the injury penetrates the eyeball, symptoms can include eye redness and sensitivity to light. Blunt trauma can cause similar symptoms, along with additional signs such as swelling or bruising and abrasions on the eyelids and adjacent skin. Severe blunt trauma that fractures the small bones behind the eyeball may result in the eye turning inward, difficulty looking upward, and numbness in the cheek beneath the eye.

Diagnosis

In diagnosing ocular trauma, a doctor will first monitor vital signs like pulse and blood pressure, as these can be affected by eye injuries. Direct examination of the eye includes assessing visual acuity, light reflex, and visual fields. Intraocular pressure test is typically avoided in cases of sharp trauma to prevent exacerbating the injury, but it may be checked in blunt trauma to assess the likelihood of internal bleeding. Eye drops are also avoided in cases of open or penetrating wounds.

The doctor will palpate the adjacent eye tissues gently to check for damage. Imaging techniques such as X-rays and CT scans can help evaluate the condition of the bones and surrounding tissue. MRI may also be used unless metal objects are involved in the trauma. The movement of the eyeball is examined to detect any damage to the ocular muscles. A slit lamp examination may be conducted to assess structures within the eye, such as cataracts in the lens, retinal detachment, or the presence of foreign objects inside the eye.

Management

The treatments of ocular trauma depend on the type and severity of the injury. For mild blunt trauma, treatment includes compressing the eye with a cold compress to reduce bleeding and swelling, taking pain medication, and taking bed rest to prevent further trauma. Surgery may be required if there is cloudiness in the eye, indicating a high risk of glaucoma (increased intraocular pressure). Medications to reduce intraocular pressure may also be prescribed. Cataracts resulting from trauma are another indication for surgery.

For sharp trauma, antibiotics are crucial to prevent infection. Pain relievers, intraocular pressure reducers, and pupil-constricting medications may be administered to reduce inflammation and pain. Surgery may be necessary in cases of cataracts, glaucoma, or when a foreign object has penetrated the eyeball.

In cases of severe eyeball damage, laxatives and cough suppressants may be prescribed to prevent sudden increases in eye pressure caused by straining or coughing, which could worsen the injury.

Complications

Various complications can arise from ocular trauma. One of the primary complications is cataract formation, where the eye lens becomes cloudy due to lens damage. Cataract can occur after eye injury if the injury affects the lens. 

Additionally, glaucoma, or increased intraocular pressure, can occur due to damage to the lens or other anterior structures of the eye. If the trauma affects the eye muscles, it can lead to a decrease in pulse rate, potentially causing shock or circulatory failure. Sharp or penetrating injuries carry an increased risk of infection within the eyeball, which can lead to blindness irrespective of infection presence.

Prevention

Preventing ocular trauma involves addressing existing risk factors. Some preventive measures include:

• Wearing protective eyewear while working to shield the eyes from particles that could penetrate the eyeball or from direct impacts affecting the eyes.
• Using a helmet with a face shield when riding a motorcycle to prevent direct impact to the eyes should accidents occur.
• Wearing eye protection during sports, especially those involving balls or shuttlecocks, to prevent blunt or sharp trauma to the eyes.

When Do You Have To Go To A Doctor?

If your eyes are attracted to particles of objects that are small enough or hit, you can consider going to the doctor. If objects are small enough, you may need help from others to check whether the object looks stuck or not. If the object looks stuck, you need to go to the doctor immediately. Meanwhile, if your eyes are hit by a blunt object, you should check with the doctor if the skin around the eyeball looks bruised or swollen, or if your gaze becomes blurry or double.

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