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Overview of Eye Injuries

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

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 tolerate minor impact at times without damage.

Because of these protective features, many eye injuries do not affect the eyeball and are thus not dangerous, even though extensive bruising and swelling to surrounding structures may make them look worse than they are. However, injury occasionally damages the eye so severely that vision is affected and sometimes completely lost. In rare instances, the eye must be removed.

Structures That Protect the Eye

Causes

Common causes of eye injury include domestic or industrial accidents (for instance, from using a hammer or liquid chemicals or cleaners), 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)

  • Structures surrounding the eye (see Black Eye and see Fractures of the Orbit)

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 fracture) can result.

Evaluation

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.

Prevention

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. Specific protective eyewear is available for a variety of sports as well as for construction work.

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  • AKPENTOLATE, CYCLOGYL
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