Trauma
Eye Injury
search
Eye Injury
, Eye Trauma, Eye Evaluation in Trauma
See Also
Sports Related Eye Injury
Eye Tray
Epidemiology
Incidence
: 500,000 eye injuries per year in United States
Males represent 80% of eye injuries, typically in their later 20s
Two thirds of eye injuries are related to hammering
Types
Common Eye Injuries
Corneal Abrasion
or
Cornea
l
Laceration
Globe Rupture
Blunt Eye Trauma
Eye Foreign Body
Eye Chemical Burn
History
Type of work being performed at time of injury?
Tools being used (e.g. high velocity power tool, hammering)?
Working with metal or wood?
Wearing
Eye Protection
at the time of the injury?
Baseline
Visual Acuity
?
Glasses or contacts use (and are contacts in the eye currently)?
Exam
Topical Eye Anesthetic
(e.g. Tetracaine) may allow for adequate
Eye Exam
Avoid if signs of
Globe Perforation
Visual Acuity
(always)
Consider
Topical Eye Anesthetic
first if light sensitive
Delay only in cases of
Chemical Eye Injury
(irrigation precedes acuity exam)
Use
Snellen Chart
(if <20/200, check finger counting, hand movement, light perception)
Visual Field
s by confrontation
Defect suggests
Retina
l,
Optic Nerve
or CNS injury
External eye findings
Eyelid Ecchymosis
Proptosis
(
Retrobulbar Hematoma
)
Trismus
suggests lateral
Orbital Wall Fracture
CN 5
-
Maxilla
ry branch
Paresthesia
s suggests orbital floor
Fracture
Palpate orbital rim for tenderness, deformity or defect
Extraocular Movement
Upward gaze problem suggests orbital floor
Fracture
Pupil
exam
Evaluate for pupil size and reactivity
Swinging Flashlight Test
Evaluate for
Afferent Pupillary Defect
(abnormal,
Pupil Dilation
in response to light)
Afferent Pupillary Defect
suggests a more serious Eye Injury with worse prognosis
Schmidt (2008) Ophthalmology 115(1): 202-9 +PMID:17588667 [PubMed]
Tear drop shaped or peaked pupil suggests
Globe Rupture
Eyelid
s
Evert upper
Eyelid
to observe for
Eye Foreign Body
Sweep upper and lower
Eyelid
s with a moistened cotton swab
Fluorescein
stain
Corneal Epithelial Disruption
(e.g.
Corneal Abrasion
,
Cornea
l
Laceration
)
Seidel Test
(evaluation of
Globe Rupture
)
Vitreous fluid leaks from eye and dilutes
Fluorescein
Slit Lamp
Exam of
Conjunctiva
,
Cornea
and anterior chamber exam
Foreign body
Corneal Abrasion
or
Laceration
Hyphema
Chemosis
Conjunctiva
l injection
Funduscopic Exam
(
Red Reflex
)
Altered
Red Reflex
suggests serious Eye Injury
Other tests
Intraocular Pressure
testing should be avoided in suspected
Globe Rupture
Evaluation
Red Flags (require immediate ophthalmology evaluation)
Sudden decrease in
Visual Acuity
Visual Field
defect
Painful
Extraocular Movement
s
Photophobia
Diplopia
Proptosis
Light Flashes
or
Floaters
Pupil
with irregular shape (e.g. tear drop)
Hyphema
Lights seen with halos
Suspected
Globe Rupture
(e.g. broken eyeglasses)
Medial canthus injury
Precautions
Initial poor
Visual Acuity
at presentation does NOT irrevocably predict
Vision Loss
Even those with complete
Vision Loss
initially, have a significant chance of regaining near normal vision
May (2000) Graefes Arch Clin Exp Ophthalmol 238(2):153-7 +PMID:10766285 [PubMed]
Imaging
Intraocular foreign body
Orbital Ultrasound
Contraindicated in
Globe Rupture
May help identify occult foreign body
However,
Exercise
caution in applying pressure with probe
CT Orbits
First-line study for intraocular foreign body
Test Sensitivity
: 60-100% for identify foreign body
Best efficacy for larger foreign bodies, glass, metal, stone
Negative CT Orbits does not exclude foreign body
Complications
Intraocular foreign body
Endophthalmitis
(30%)
Eye enucleation (8%)
Complete
Vision Loss
(5%)
Management
Intraocular Foreign Body
Consult ophthalmology early, emergently
Ophthalmology intervention within 24 hours improves outcomes
Decreased
Endophthalmitis
risk
Improved outcome in
Visual Acuity
Tetanus
Vaccine
Broad-spectrum parenteral antibiotics to prevent
Endophthalmitis
Vancomycin
AND
Ceftazidime
or
Fluoroquinolone
Prevention
See
Eye Protection
Hammering is a major cause of Eye Injury (use
Eye Protection
!)
References
Jhun and Swaminathan in Herbert (2015) EM:Rap 15(6):12-13
Lezrek (2015) Ann Emerg Med 65(6): 636 [PubMed]
Naradzay (2006) Med Clin N Am 90:305-28 [PubMed]
Pokhrel (2007) Am Fam Physician 76:829-36 [PubMed]
Type your search phrase here