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Blunt Injuries to the Eye

by Kathryn Colby, MD, PhD

A blunt impact may damage the structures at the front of the eye (the eyelid, conjunctiva, sclera, cornea, iris, and lens) and those at the back of the eye (retina and optic nerve). Such an impact may also break (fracture) the bones that surround the eye. Blunt trauma occasionally also results in cuts (lacerations) to the tissues of the eye.

Injured eyes may be very swollen and difficult to open. Still, doctors need to open the eyes to examine them and make sure there is no injury that will affect vision. The eyes almost always can be opened gently, although instruments may be needed to do so.

Black Eye

In the first 24 hours after a blunt eye injury, blood may leak into the skin of the eyelid and surrounding areas, causing swelling and a bruise (contusion), commonly called a black eye. The blood usually drains toward the bottom of the eye after a day or two, resulting in swelling and discoloration just below the lower eyelid. Black eyes themselves have no effect on vision, although other eye injuries that accompany them may be serious.

Black eyes resolve without treatment after a few days or weeks. During the first 24 to 48 hours, ice packs may help reduce swelling and ease the pain of a black eye. After the first 24 to 48 hours, warm compresses may be applied to aid absorption of the blood. Nonsteroidal anti-inflammatory drugs (NSAIDs, such as aspirin or ibuprofen) or acetaminophen can be given if the pain is significant. However, people who have bleeding within the eye should probably not use NSAIDs, which may worsen bleeding.

Subconjunctival Hemorrhage

A blood vessel on the conjunctiva (the thin layer of tissue that covers most of the eye’s surface) may break, causing a solid red patch of blood on the white of the eye. Sometimes the whole white of the eye appears red. The blood lies under the conjunctiva (subconjunctival hemorrhage) and is on the eye surface. Therefore, although the blood may look alarming, it is minor and resolves without treatment. The red area may briefly become yellow after about a week. All traces of the blood typically disappear within 1 to 2 weeks. A subconjunctival hemorrhage often occurs together with a black eye.

Hyphema

A hyphema (anterior chamber hemorrhage) is bleeding into the front chamber (the fluid-filled space between the clear cornea and the colored iris—see see Figure: ) of the eye. Additional bleeding may occur up to several days after the injury. A hyphema may result in permanent, partial, or complete loss of vision. Vision loss may be caused by increased pressure within the eye (glaucoma), by blood staining the cornea, or both.

People with hyphema often have blurred vision and pain when exposed to bright light. If the hyphema is large enough, a layer of blood is visible behind the lower part of the cornea when the person is upright. However, the layer may be so small that it can be seen only with magnification.

Treatment

A person with a hyphema should be examined by an ophthalmologist (a medical doctor who specializes in eye disorders) as soon as possible. Some people with severe bleeding or bleeding disorders (which make bleeding more likely) or who take anticoagulant drugs may need to be treated in the hospital.

Treatment usually involves bed rest with the head of the bed elevated to encourage the blood to settle. Eye drops are often given to dilate the pupil (such as atropine) and to reduce inflammation within the eye (usually corticosteroids). A protective shield is taped over the eye to prevent further injury.

Pressure within the eye is measured at least once daily for the first few days. If the pressure is elevated, people may have nausea, eye ache, and decreased vision. The ophthalmologist may give eye drops such as those used to treat glaucoma to decrease the pressure. Aspirin and other nonsteroidal anti-inflammatory drugs, which can predispose to bleeding, should be avoided for several weeks. Because a hyphema increases the life-long risk of developing glaucoma, people who have had a hyphema should have their eyes examined every year.

If bleeding recurs, an ophthalmologist may give aminocaproic acid, a drug that hastens blood clotting. Rarely if recurrent bleeding causes increrased pressure in the eye, the blood may need to be drained surgically.

Retinal Detachment

Blunt injury may cause part of the retina or the entire retina to tear or to separate (detach) from its underlying surface at the back of the eyeball (see also see Detachment of the Retina). Usually, only part of the retina is detached (often the outside edge, or peripheral part, of the retina), but if treatment does not occur soon, more of the retina can detach.

Initially, retinal detachment may create images of irregular dark floating shapes (floaters) or flashes of light. Parts of vision may be blurred or lost, usually side (peripheral) vision. If more of the retina detaches, more vision is blurred or lost.

A person with these symptoms needs to see a doctor as soon as possible. The diagnosis is made by an ophthalmologist, who examines the back of the eye with a bright light (ophthalmoscopy) after the eye has been dilated. Sometimes an ultrasound examination is done. An ophthalmologist can sometimes reattach a detached retina or prevent the injury from worsening by using various treatments such as surgery, lasers, or freezing therapy (cryopexy).

Other Blunt Injuries to the Eyeball

Other injuries that can occur after a blunt force include bleeding in the back section of the eye (vitreous hemorrhage), tearing of the iris, and displacement (dislocation) of the lens. Usually, the force required to cause these injuries is high. Affected people tend to have obvious, severe eye injuries with many abnormalities. All affected people have impaired vision. Examination by an ophthalmologist and treatment should occur as soon as possible.

Drugs Mentioned In This Article

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  • ADVIL, MOTRIN IB
  • No US brand name
  • TYLENOL
  • ATROPEN