Eye Injury

Aka: Eye Injury, Eye Trauma, Eye Evaluation in Trauma

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II. Epidemiology

  1. Incidence: 500,000 eye injuries per year in United States
  2. Males represent 80% of eye injuries, typically in their later 20s
  3. Two thirds of eye injuries are related to hammering

III. Types: Common Eye Injuries

  1. Corneal Abrasion or Corneal Laceration
  2. Globe Rupture
  3. Blunt Eye Trauma
  4. Eye Foreign Body
  5. Eye Chemical Burn

IV. History

  1. Type of work being performed at time of injury?
  2. Tools being used (e.g. high velocity power tool, hammering)?
  3. Working with metal or wood?
  4. Wearing Eye Protection at the time of the injury?
  5. Baseline Visual Acuity?
  6. Glasses or contacts use (and are contacts in the eye currently)?

V. Exam

  1. Topical Eye Anesthetic (e.g. Tetracaine) may allow for adequate Eye Exam
    1. Avoid if signs of Globe Perforation
  2. Visual Acuity (always)
    1. Consider Topical Eye Anesthetic first if light sensitive
    2. Delay only in cases of Chemical Eye Injury (irrigation precedes acuity exam)
    3. Use Snellen Chart (if <20/200, check finger counting, hand movement, light Perception)
  3. Visual Fields by confrontation
    1. Defect suggests Retinal, Optic Nerve or CNS injury
  4. External eye findings
    1. Eyelid Ecchymosis
    2. Proptosis (Retrobulbar Hematoma)
    3. Trismus suggests lateral Orbital Wall Fracture
    4. CN 5 - Maxillary branch Paresthesias suggests orbital floor Fracture
    5. Palpate orbital rim for tenderness, deformity or defect
  5. Extraocular Movement
    1. Upward gaze problem suggests orbital floor Fracture
  6. Pupil exam
    1. Evaluate for pupil size and reactivity
    2. Swinging Flashlight Test
      1. Evaluate for Afferent Pupillary Defect (abnormal, Pupil Dilation in response to light)
      2. Afferent Pupillary Defect suggests a more serious Eye Injury with worse prognosis
      3. Schmidt (2008) Ophthalmology 115(1): 202-9 +PMID:17588667 [PubMed]
    3. Tear drop shaped or peaked pupil suggests Globe Rupture
  7. Eyelids
    1. Evert upper Eyelid to observe for Eye Foreign Body
    2. Sweep upper and lower Eyelids with a moistened cotton swab
  8. Fluorescein stain
    1. Corneal Epithelial Disruption (e.g. Corneal Abrasion, Corneal Laceration)
    2. Seidel Test (evaluation of Globe Rupture)
      1. Vitreous fluid leaks from eye and dilutes Fluorescein
  9. Slit Lamp Exam of Conjunctiva, Cornea and anterior chamber exam
    1. Foreign body
    2. Corneal Abrasion or Laceration
    3. Hyphema
    4. Chemosis
    5. Conjunctival injection
  10. Funduscopic Exam (Red Reflex)
    1. Altered Red Reflex suggests serious Eye Injury
  11. Other tests
    1. Intraocular Pressure testing should be avoided in suspected Globe Rupture

VI. Evaluation: Red Flags (require immediate ophthalmology evaluation)

  1. Sudden decrease in Visual Acuity or Acute Vision Loss
  2. Visual Field Defect
  3. Painful or reduced Extraocular Movements
  4. Photophobia
  5. Diplopia
  6. Proptosis
  7. Light Flashes or Floaters
  8. Pupil with irregular shape (e.g. tear drop)
  9. Hyphema
  10. Lights seen with halos
  11. Suspected Globe Rupture (e.g. broken eyeglasses)
  12. Medial canthus injury

VII. Evaluation: Children with Non-Penetrating Eye Injury

  1. Evaluation
    1. Concurrent other Trauma (see Pediatric Trauma)
    2. Visual Acuity
      1. Sudden decrease in Visual Acuity is a red flag
      2. Serious causes of Vision Loss include retrobulbar neuritis, Choroid rupture, Retinal Detachment
    3. Extraocular Movements
    4. Pupillary Light Reflex and Blink Reflex to light (non-verbal children)
    5. Consult pediatric ophthalmology as needed
  2. Important injuries to consider
    1. Globe Rupture
    2. Orbital Fracture
    3. Chemical Eye Injury
    4. Hyphema
    5. Corneal Abrasion
    6. Traumatic Iritis or Uveitis
      1. Subacute presentation at 24 to 72 hours after injury
      2. Presents with Eye Pain, redness and light sensitivity
  3. References
    1. Grzybowski and Ponce (2021) Crit Dec Emerg Med 34(7): 23

VIII. Precautions

  1. Initial poor Visual Acuity at presentation does NOT irrevocably predict Vision Loss
    1. Even those with complete Vision Loss initially, have a significant chance of regaining near normal Vision
    2. May (2000) Graefes Arch Clin Exp Ophthalmol 238(2):153-7 +PMID:10766285 [PubMed]

IX. Imaging: Intraocular foreign body

  1. Orbital Ultrasound
    1. Contraindicated in Globe Rupture
    2. May help identify occult foreign body
      1. However, Exercise caution in applying pressure with probe
  2. CT Orbits
    1. First-line study for intraocular foreign body
    2. Test Sensitivity: 60-100% for identify foreign body
      1. Best efficacy for larger foreign bodies, glass, metal, stone
      2. Negative CT Orbits does not exclude foreign body

X. Complications: Intraocular foreign body

  1. Endophthalmitis (30%)
  2. Eye enucleation (8%)
  3. Complete Vision Loss (5%)

XI. Management: Intraocular Foreign Body

  1. Consult ophthalmology early, emergently
  2. Ophthalmology intervention within 24 hours improves outcomes
    1. Decreased Endophthalmitis risk
    2. Improved outcome in Visual Acuity
  3. Tetanus Vaccine
    1. Broad-spectrum ParenteralAntibiotics to prevent Endophthalmitis
      1. Vancomycin AND
      2. Ceftazidime or Fluoroquinolone

XII. Prevention

  1. See Eye Protection
  2. Hammering is a major cause of Eye Injury (use Eye Protection!)

XIII. References

  1. Jhun and Swaminathan in Herbert (2015) EM:Rap 15(6):12-13
  2. Lezrek (2015) Ann Emerg Med 65(6): 636 [PubMed]
  3. Naradzay (2006) Med Clin N Am 90:305-28 [PubMed]
  4. Pokhrel (2007) Am Fam Physician 76:829-36 [PubMed]

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Related Studies

Ontology: Eye Injuries (C0015408)

Definition (MEDLINEPLUS)

The structure of your face helps protect your eyes from injury. Still, injuries can damage your eye, sometimes severely enough that you could lose your vision. Most eye injuries are preventable. If you play sports or work in certain jobs, you may need protection.

The most common type of injury happens when something irritates the outer surface of your eye. Certain jobs such as industrial jobs or hobbies such as carpentry make this type of injury more likely. It's also more likely if you wear contact lenses.

Chemicals or heat can burn your eyes. With chemicals, the pain may cause you to close your eyes. This traps the irritant next to the eye and may cause more damage. You should wash out your eye right away while you wait for medical help.
Definition (NCI) Damage to the eye.
Definition (MSH) Damage or trauma inflicted to the eye by external means. The concept includes both surface injuries and intraocular injuries.
Definition (CSP) damage or trauma inflicted to the eye by external means including both surface injuries and intraocular injuries.
Concepts Injury or Poisoning (T037)
MSH D005131
ICD10 S05.9 , S00-S09
SnomedCT 367423000, 157358003, 125669007, 269350004, 211485000, 367132005, 21839005
LNC LA17539-0
English Injuries, Eye, Eye Injury, Injury, Eye, Injury of eye, EYE INJ, INJ EYE, Ocular injury, Eye injury NOS, Ocular injuries, Injury of eye NOS, injuries of eye, Eye Injuries [Disease/Finding], ocular injury, Injury;eye, ocular injuries, eye injuries, eye trauma, eye injury (diagnosis), eye injury, Eye Injuries, Injury of eye (disorder), INJURY, EYE, Injury of Eye Region, EYE INJURY, Injury-eye, Eye injury, eye; injury, injury; eye, ocular; wound, wound; ocular, Injury of eye, NOS, Ocular Injury
Italian Lesioni traumatiche dell'occhio, Traumatismo dell'occhio, Traumatismo dell'occhio, NAS, Lesioni dell'occhio
Dutch oogletsel NAO, letsel; oog, oculair; wond, oog; letsel, wond; oculair, oogletsels, oogletsel, Letsel, oog-, Oogletsel, Oogletsels, Oogverwonding
French Traumatisme oculaire SAI, Lésions traumatiques de l'oeil, Lésions traumatiques des yeux, Blessures de l'oeil, Blessures des yeux, Traumatismes oculaires, Lésions oculaires, Lésions traumatiques oculaires, Blessures oculaires, Traumatisme oculaire, Traumatisme de l'oeil, Traumatisme des yeux
German Augenverletzung NNB, Augenverletzung, Augenverletzungen, Verletzungen, Augen-
Portuguese Lesão ocular traumática NE, Lesões Oculares, Lesão ocular traumática, Lesões traumáticas oculares, Traumatismos Oculares
Spanish Lesión traumática del ojo NEOM, lesión traumática del ojo, lesión traumática del ojo (trastorno), Traumatismos Oculares, injuria ocular, Lesiones traumáticas oculares, Lesión traumática del ojo, Lesiones Oculares
Japanese 眼球外傷, 眼外傷ＮＯＳ, ｶﾞﾝｷｭｳｶﾞｲｼｮｳ, ｶﾞﾝｶﾞｲｼｮｳ, ｶﾞﾝｶﾞｲｼｮｳNOS, 外傷-眼, 眼外傷, 眼の創傷, 眼の損傷, 眼部外傷
Swedish Ögonskador
Czech oči - poranění, Zranění oka, Poranění oka, Poranění oka NOS, oči - zranění, poranění oka, úrazy oka
Finnish Silmävammat
Russian GLAZA RANY I TRAVMY, GLAZ, RANY I TRAVMY, ГЛАЗА РАНЫ И ТРАВМЫ, ГЛАЗ, РАНЫ И ТРАВМЫ
Croatian OČNE OZLJEDE
Polish Urazy oka
Hungarian Ocularis sérülések, Szemsérülés, Szemsérülés k.m.n.
Norwegian Øyeskader
Derived from the NIH UMLS (Unified Medical Language System)

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