The structure of the face and eyes is well suited for protecting the eyes from injury. The eyeball is set into the orbit, a socket surrounded by a strong, bony ridge. The eyelids close quickly to form a barrier to foreign objects, and the eye can at times tolerate minor impact without damage.
Because of these protective features, many eye injuries may not affect the eyeball or cause significant damage. However, injuries should be evaluated because occasionally there is damage to the eye that needs treatment or impacts vision. In rare instances, vision may be completely lost or the eye must be removed.
Structures That Protect the Eye
Causes of Eye Injuries
Common causes of eye injury include domestic or industrial accidents (for instance, from using a hammer [see Intraocular Foreign Bodies Intraocular Foreign Bodies Foreign bodies that penetrate the eyeball are rare but can lead to a serious infection and complications including a risk of developing blindness. (See also Overview of Eye Injuries.) Explosions... read more ] or liquid chemicals or cleaners [see Burns to the Eye Burns to the Eye Burns to the eye can occur after heat- or chemical-related injuries and can result in serious complications, including permanent blindness. (See also Overview of Eye Injuries.) The eyelids close... read more ]), assault, sports injuries (including air-gun or paint pellet-gun injuries), and motor vehicle crashes (including air-bag injuries). Exposure to strong ultraviolet light, as from a welding arc or bright sunlight reflected off snow, can injure the transparent dome on the front surface of the eye (cornea—see Superficial Punctate Keratitis Superficial Punctate Keratitis Superficial punctate keratitis is an eye disorder caused by death of small groups of cells on the surface of the cornea (the clear layer in front of the iris and pupil). The eyes become red... read more ). People with eye injuries may also have other head or neck injuries.
An impact may cause eye injury and damage the
Structures at the front of the eye (the eyelid, conjunctiva, sclera, cornea, iris, and lens Corneal Abrasions and Corneal Foreign Bodies Foreign bodies in the cornea cause abrasions, resulting in pain and redness, and lead to infections, even after they are removed. Most of these injuries are minor. (See also Overview of Eye... read more )
Structures at the back of the eye (retina and optic nerve Retinal Detachment Caused by Injury to the Eye The retina is the light-sensitive structure at the back of the eye. Blunt injury may cause part of the retina or the entire retina to tear or to separate (detach) from its underlying surface... read more )
Structures surrounding the eye (see Black Eye 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. (See... read more and Fractures of the Orbit Fractures of the Orbit A severe blow to the face can fracture any of several bones that form the orbit (the bony cavity that contains the eyeball, muscles, nerves, and blood vessels, as well as the structures that... read more )
Impact can cause bruising (contusion) and cuts (lacerations Eyelid and Eyeball Lacerations Most cuts (lacerations) around the eyes affect the eyelids rather than the eyeball. (See also Overview of Eye Injuries.) If the skin around the eye or on the eyelid has been cut, stitches may... read more ) to the tissues of the eye. Bleeding in the front of the eye (hyphema Hyphema A hyphema is bleeding into the front chamber (the fluid-filled space between the clear cornea and the colored iris) of the eye. Additional bleeding (rebleeding) may occur up to several days... read more ), back section of the eye (vitreous hemorrhage), tearing of the iris Traumatic Iritis and Chemical Iritis Iritis is inflammation of the pigmented inside lining of the eye (uvea), iris, or both. (See also Overview of Eye Injuries.) Iritis can develop after blunt eye trauma or a chemical burn, typically... read more , displacement (dislocation) of the lens, and breaking (fracturing) the bones that surround the eye (orbital fractures Fractures of the Orbit A severe blow to the face can fracture any of several bones that form the orbit (the bony cavity that contains the eyeball, muscles, nerves, and blood vessels, as well as the structures that... read more ) can result.
Evaluation of Eye Injuries
A person with an eye injury should be examined by a doctor. Glasses (if worn) should be brought so that the person’s vision can be assessed with their normal correction. This assessment can help the doctor know whether any abnormal vision is a new problem or an old one.
The eye examination may include a careful evaluation of the pupil (the black dot in the middle of the eye) and eye movements as well as a slit-lamp examination Slit-Lamp Examination A person who has eye symptoms should be checked by a doctor. However, some eye disorders cause few or no symptoms in their early stages, so the eyes should be checked regularly (every 1 to 2... read more and ophthalmoscopy Ophthalmoscopy A person who has eye symptoms should be checked by a doctor. However, some eye disorders cause few or no symptoms in their early stages, so the eyes should be checked regularly (every 1 to 2... read more . The slit lamp contains a light, an adjustable binocular magnifying instrument, and a table that adjusts the position of these components. A slit-lamp examination assesses mainly the front of the eye, particularly the eye surface and eyelid. Ophthalmoscopy assesses mainly the back of the eye. Often, ophthalmoscopy is done after the eye is dilated with eye drops such as cyclopentolate and phenylephrine. After dilation, more of the eye can be seen, particularly the retina.
If the injury is serious, particularly if the vision is affected, the doctor who first examines the person arranges for an ophthalmologist (a medical doctor who specializes in the evaluation and treatment—surgical and nonsurgical—of eye disorders) to evaluate and treat the person. Injured eyes may be very swollen and difficult to open, but doctors need to open the eyes to examine them and determine what injuries will need treatment. The eyes almost always can be opened gently, although instruments may be needed to do so. This should be done with care to avoid pressure on the eyeball in case there is any laceration to the eyeball itself.
Prevention of Eye Injuries
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 eye injury. Specific protective eyewear is available for a variety of sports as well as for construction work.