Presentations / Eye trauma
Eye trauma
From the abrasion to the open globe.
The first question in any eye injury is whether the globe is open. Everything else is examined after that answer, because pressing on an open eye extrudes its contents.
Hit in the eye by a ballOpen in the atlas
Is the globe open?
Emergent · nowA history of a sharp object, a hammer on metal, or a high-velocity fragment. A peaked or teardrop pupil pointing at the wound. Dark uveal tissue at the limbus or a wound. A flat or unusually deep anterior chamber. A soft eye. A positive Seidel test: fluorescein on the wound is washed away by a stream of clear aqueous. If any of these, stop: shield the eye without pressing, no pad, no drops other than what the ophthalmologist asks for, nil by mouth, antiemetics, tetanus, a CT for a foreign body, and the theatre.
The rest, once it is closed
Lid lacerations (the margin, the canaliculus and the levator need specialist repair). Corneal abrasion and foreign bodies, including the one under the everted upper lid. A hyphaema after a blunt blow, with its rebleed and pressure risks. An orbital floor fracture: a numb cheek, enophthalmos, diplopia in upgaze, a trapped inferior rectus. Commotio retinae and a retinal dialysis at the periphery after blunt trauma. And traumatic optic neuropathy, an afferent defect with a normal-looking eye.
| Injury | The clue | Do | Urgency |
|---|---|---|---|
| Chemical injury | Alkali or acid in the eye | Irrigate first, for 30 minutes, until the pH is neutral | Emergent |
| Corneal abrasion | Pain, watering, a staining defect | Lubricants, chloramphenicol; heals in days | Routine to soon |
| Corneal or subtarsal foreign body | Grit sensation; a scratch that follows the blink | Evert the lid; remove under anaesthetic at the slit lamp | Soon |
| Hyphaema | Blood in the chamber after a blow | Shield, rest head up, check the pressure, no antiplatelets | Urgent |
| Orbital floor fracture | Numb cheek, diplopia looking up | CT; do not blow the nose; surgery if trapped | Urgent |
| Open globe | Peaked pupil, uvea at the wound, Seidel positive | Shield, nil by mouth, CT, theatre | Emergent |
Go and look
Where this topic leads