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Overview of Eye Trauma

By Ann P. Murchison, MD, MPH, Director; Associate Professor of Ophthalmology, Wills Eye Emergency Department, Wills Eye Hospital; Thomas Jefferson University

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(See also Retinal Detachment.)

Common causes of eye injury include domestic accidents (eg, during hammering or exposure to household chemicals or cleaners), assault, sporting injuries (including air- or paint pellet-gun injuries), and motor vehicle crashes (including airbag injuries). Injury may be to the eyeball (globe), surrounding soft tissues (including muscles, nerves, and tendons), and/or bones of the orbit.

General evaluation should include the following:

  • Tests of visual acuity

  • Range of extraocular motion

  • Visual fields to confrontation

  • Pupillary appearance and responses

  • Location and depth of lid and conjunctival lacerations and of foreign bodies

  • Depth of anterior chamber

  • Presence of anterior chamber or vitreous hemorrhage, cataract, or red reflex

  • Retinal examination

  • Intraocular pressure determination

Detailed examination of the sclera, anterior segment (cornea, anterior chamber, ciliary body, iris), lens, and anterior vitreous is best done with a slit lamp. Although direct ophthalmoscopy can be used to examine the lens and posterior structures of the eye, indirect ophthalmoscopy, usually done by an ophthalmologist, provides a more detailed and binocular view of these structures. Indications for indirect ophthalmoscopy include clinical suspicion of vitreous abnormalities (eg, hemorrhage, foreign body) and retinal abnormalities; clinical suspicion may be based on symptoms, injury mechanism, absence of the red reflex, or retinal abnormalities (visible with direct ophthalmoscopy). Because direct and indirect ophthalmoscopy are best done through a dilated pupil, about 15 to 30 min before this examination, mydriatics (such as 1 drop of cyclopentolate 1% and 1 drop of phenylephrine 2.5%) can be instilled. If an intraocular or orbital foreign body or an orbital fracture is suspected, CT is done.

Use of eye guards, goggles, or special eyeglasses, such as those constructed of polycarbonate lenses in a wrap-around polyamide frame, is a simple precaution that greatly reduces the risk of injury.

When eye drops are prescribed, each dose includes only one drop.

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