Eyelid and Eyeball Lacerations
(See also Overview of Eye Injuries.)
If the skin around the eye or on the eyelid has been cut, stitches may be needed. When possible, stitches near the edge of the eyelid should be placed by an ophthalmologist (a medical doctor who specializes in the evaluation and treatment—surgical and nonsurgical—of eye disorders) to ensure that no deformities develop that will affect the way the eyelids close and move over the cornea (at the front of the eye). An injury that causes the eyelid to droop, goes through the entire thickness of the eyelid, or affects the tear ducts (ducts that drain tears off of the eye) also should be repaired by an ophthalmologist. The tear ducts are in parts of both the lower and upper eyelids nearest the nose.
Of those lacerations that affect the eyeball, many are superficial. However, some cuts go through the white of the eye (sclera) or the transparent dome on the front surface of the eye (cornea), penetrating the eye’s interior. Such cuts are considered a rupture of the eyeball (globe). The globe also can be ruptured by a blunt force. Most people with a ruptured globe have decreased vision. The eye is often obviously distorted, and the pupil may be shaped like a teardrop. Sometimes fluid leaks out of the eye. Excessive bleeding under the conjunctiva (the thin mucous membrane that covers the cornea) is sometimes a symptom of a ruptured globe.
Eyeball lacerations can seriously damage the structures necessary for vision and make eyeball infection (endophthalmitis) more likely.
A laceration to the eyeball requires an immediate evaluation by an ophthalmologist (a medical doctor who specializes in the evaluation and treatment—surgical and nonsurgical—of eye disorders). CT is done to confirm the diagnosis and see if any foreign material is inside the eye or if there is other damage around the eye.
Even after all possible medical and surgical treatment, a serious eyeball laceration may result in partial or total loss of vision. Very rarely, after a severe eyeball laceration (or eye surgery), the uninjured eye becomes inflamed (sympathetic ophthalmia), which may result in partial loss of vision or even blindness if left untreated. Often, corticosteroid drops can effectively treat this reaction. Doctors may remove an irreversibly damaged eye with no vision to prevent sympathetic ophthalmia.
Surgical repair is often necessary for eyeball lacerations, except for some injuries that affect only a small area of the thin mucous membrane that covers the cornea (conjunctiva). Even before surgery, antibiotics are given by vein (intravenously) to reduce the chance of infection within the eye. Ointments should be avoided.
A protective shield (either a commercial product or the bottom part of a paper cup) is taped over the eye to avoid unintentional pressure that could force the contents of the eye through the laceration. If any foreign body protrudes from the eyeball or around the eyeball, it should be left in place until an ophthalmologist can see the person.
Drugs for pain are given by vein or, if surgical repair is not needed, by mouth. If necessary, vomiting can be controlled with drugs that relieve nausea. A tetanus vaccine is given as soon as possible.