Overview of Eye Injuries
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.
Common causes of eye injury include domestic or industrial accidents (for instance, from using a hammer [see Intraocular Foreign Bodies] or liquid chemicals or cleaners [see Burns to the Eye]), 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). 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)
Structures at the back of the eye (retina and optic nerve)
Impact can cause bruising (contusion) and cuts (lacerations) to the tissues of the eye. Bleeding in the front of the eye (hyphema), back section of the eye (vitreous hemorrhage), tearing of the iris, displacement (dislocation) of the lens, and breaking (fracturing) the bones that surround the eye (orbital fractures) can result.
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 and ophthalmoscopy. 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.