Traumatic eye injuries

Last updated: October 4, 2022

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The eye is a highly sensitive organ that is well-protected by the bony orbit and eyelid. Common traumatic eye injuries occur through blunt or sharp objects or chemical burns. Closed globe injuries usually follow blunt trauma and have a varied clinical presentation (superficial corneal abrasion to retinal hemorrhage). Open globe injuries usually follow sharp or high-velocity blunt trauma and present with ocular volume loss or a prolapsing uvea in addition to the sequelae of closed ocular injuries. Orbital floor fractures are a type of periocular injury following high-velocity blunt trauma to the globe and upper eyelid which present with unilateral periorbital pain, edema, and/or ecchymosis, enophthalmos, and an orbital rim “step-off” which is confirmed by CT. Chemical burns of the eye present with ocular pain, erythema, and blepharospasm. Treatment of traumatic eye injuries depends on the precise underlying injury. Chemical burns require immediate and adequate irrigation with water beginning prior to hospitalization. Urgent stabilization, antibiotics, and immediate ophthalmologic consultation is often required to rule out serious injury (e.g., severe chemical burns, open globe injuries, retinal detachment, extraocular muscle entrapment) and determine the need for surgery.

Avoid topical ointments in the presence of open globe injuries.

Patients should be advised to irrigate with a copious volume of water or saline for at least 15 minutes before arrival to the ED because immediate irrigation is the most important factor in preventing morbidity.

Complex lacerations require repair by an ophthalmologist or oculofacial plastic surgeon.

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