Traumatic eye injuries

Last updated: October 4, 2022

Summarytoggle arrow icon

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.

Closed globe contusion (bruising)toggle arrow icon

Open globe injuriestoggle arrow icon

  • Definition: full-thickness perforation or laceration of the ocular globe
  • Mechanism of injury: sharp objects or high-velocity blunt objects
  • Clinical features
  • Diagnostics
  • Treatment [4]
  • Complications [5]
    • Permanent vision loss
    • Loss of eye
    • Endophthalmitis: inflammation of the tissues or fluid inside the eye (especially with retained intraocular foreign bodies), often presenting with deep ocular pain, a red eye, and reduced visual acuity
    • Sympathetic ophthalmia: bilateral granulomatous panuveitis after unilateral penetrating injury (and rarely after intraocular surgery) → bilateral blindness may occur

Avoid topical ointments in the presence of open globe injuries.

Orbital floor fracture (blowout fracture)toggle arrow icon

Ocular chemical burnstoggle arrow icon

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.

Eyelid lacerationstoggle arrow icon

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

Referencestoggle arrow icon

  1. Nelson CC. Management of eyelid trauma. Aust N Z J Ophthalmol. 1991; 19 (4): p.357-363.doi: 10.1111/j.1442-9071.1991.tb00686.x . | Open in Read by QxMD
  2. Papadakis MA, McPhee SJ, Rabow MW. CURRENT Medical Diagnosis and Treatment 2017. Lange ; 2016
  3. Cuneyt Erdurman F, Sobaci G, Acikel CH, Ceylan MO, Durukan AH, Hurmeric V. Anatomical and functional outcomes in contusion injuries of posterior segment. Eye. 2011; 25 (8): p.1050-1056.doi: 10.1038/eye.2011.118 . | Open in Read by QxMD
  4. Commotio Retinae. Updated: February 17, 2017. Accessed: February 17, 2017.
  5. Yonekawa Y, Chodosh J, Eliott D. Surgical techniques in the management of perforating injuries of the globe. Int Ophthalmol Clin. 2013; 53 (4): p.127-137.doi: 10.1097/IIO.0b013e3182a12b01 . | Open in Read by QxMD
  6. Du Toit N, Mustak H, Cook C.. Visual outcomes in patients with open globe injuries compared to predicted outcomes using the Ocular Trauma Scoring system. Int J Ophthalmol. ; 8 (6): p.1229-1233.

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