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eye injury/trauma
Etiology:
1) mechanical injury to globe
2) chemical injury
Clinical manifestations:
1) mechanical injury to globe
a) cornea may be normal or damaged
b) irregular or deviated pupil towards the direction ofthe injury
c) hyphema
d) red eye, conjunctival hemorrhage
e) ocular pain
f) vision may be normal or decreased
2) chemical injury
a) cornea may have minor epithelial damage or be opaque
b) ocular pain
c) blurred vision
d) reflex blepharospasm
e) photophobia
f) foreign body sensation
g) red eye, conjunctivitis
Radiology:
- CT of orbit (image) [2]
Differential diagnosis:
- orbital fracture
Complications:
- blindness
- phthisis bulbi
Management:
1) generally, depending upon severity, immediate referral to ophthalmology
2) mechanical injury to globe
a) leave imbedded foreign object in place
b) avoid direct pressure on the orbit
c) protect with eye shield
d) tonometry is contraindicated
3) chemical injury
a) irrigate eye with normal saline or lactated Ringer's,
1] 1-2 liters (minimum)
2] continue eye wash enroute to emergency department
3] continue until pH tested with litmus paper normalizes [3]
4] 1-10 liters maybe necessary [3]
5] sodium bicarbonate is never appropriate [3]
b) immediate referral to ophthalmology
4) eye surgery may be necessary to remove eye foreign bodies
5) prevention
- protective eyewear [2]
Related
orbital fracture (blowout fracture)
General
eye disease (ophthalmopathy)
trauma
References
- Medical Knowledge Self Assessment Program (MKSAP) 15,
American College of Physicians, Philadelphia 2009
- Gupta PC, Ram J.
Eye Injury from a Firecracker.
N Engl J Med 2017; 376:2579. June 29, 2017
PMID: 28657877
http://www.nejm.org/doi/full/10.1056/NEJMicm1616104
- NEJM Knowledge+ Ophthalmology
- Pargament JM, Armenia J, Nerad JA.
Physical and chemical injuries to eyes and eyelids.
Clin Dermatol. 2015 Mar-Apr;33(2):234-7.
PMID: 25704943 Review.