Ocular injuries



Approximately 387,000 patients per year present with eye injuries and children represent up to 1/3 of those injured.

Among the leading causes of deprivation amblyopia, bilateral lower vision, noncongenital monocular blindness, and long term acquired visual disability.

Children’s visual systems are not fully developed rendering them particularly vulnerable to injury.

Premature disability and physical and psychological consequences disproportionately affect the lives of children.

Blunt eye injury occurs when the eye is hit by a dull object, and a lacerating injury occurs when the sharp object hits the eye.

Blunt eye injury is more common than a lacerating injury and can result from falls, motor vehicle accidents, and airbag deployment.

An open globe injury involves loss of integrity with compromise of the cornea or sclera.

Open globe injuries are associated with severe pain, reduced vision,hyphema , and pupillary distortion toward the wound.

Lacerating eye injuries can be caused by scissors or other sharp objects that are seen in workplace injuries.

If eye trauma leads to corneal abrasion, surface layers of the cornea can be rubbed off and this is associated with pain and tearing.

Corneal abrasion injuries usually recover within a few days.

Physical or chemical injuries of the eye can be a serious threat to vision.

The most obvious presentation of ocular injuries is redness and pain of the affected eyes.

Small metallic projectiles may cause neither symptom.

Intraocular foreign bodies do not cause pain because of the lack of nerve endings in the vitreous humour and retina that can transmit pain sensations.

Flicking sand, flying pieces of wood, metal, glass and stone are notorious for causing much of the

Eye trauma commonly associated with sand, flying pieces of wood, metal, glass and stone, sport associated injuries, flying high speed objects, B.B. guns, firecrackers, children’s games, fistfights, and automobile accidents.

Automobile accidents with head and facial trauma may have eye injuries that are severe in nature with multiple lacerations, shards of glass in tissues, orbital fractures, hematoma and penetrating open-globe injuries with prolapse of eye contents.

About 5.3 million cases of foreign bodies in the eyes were reported in 2013.




Ocular trauma is the leading cause of monocular vision loss in the United States, with 1/3 of serious injuries resulting in eventual blindness.


Globe rupture and perforation are a  major risk factors for the development of blindness from ocular trauma.


Greater than  90% of ocular trauma cases are preventable.


Preventing eye trauma and open globe injuries should target males, individuals at risk for falls, and those from low socioeconomic background.


Injuries are found more in males in both rural and urban population

In 0–10 age group, the difference between males and females is less.

Chemical injuries are the commonest cause of bilateral injuries in the eye.

Ocular chemical injuries often result from splashes of products that include household cleaners, industrial chemicals, cement, or automotive fluids. 

The first step in treatment of a chemical injury is irrigation with sterile isotonic saline /or lactated  ringers or tapwater. 

Topical anesthetic reduces pain and facilitated proper irrigation.

Alkaline burns are more harmful than acid burns due to the lipophilic nature allowing the to penetrate the eye more rapidly and accumulate in tissues.

Complications following eye injury include: corneal scarring, hyphema, post-traumatic glaucoma, uveitis cataract, vitreous hemorrhage and retinal detachment.

In a closed globe injury the eye globe is intact, but the seven rings of the eye have been affected by blunt trauma.

Types of closed globe injury include: 1) Contusion 2)Lamellar Laceration

In Open globe injury there is a full thickness injury of the eye wall involving cornea and sclera.

Open globe injury includes:

Globe rupture:caused by blunt trauma and is an inside-out injury.

Globe laceration: It is full-thickness wound caused by sharp objects, and includes:

1)Penetrating trauma

In penetrating trauma the globe integrity is disrupted by a full-thickness entry wound and may be associated with prolapse of the internal contents of the eye.

2) Perforating trauma

In perforating trauma the globe integrity is disrupted in two places due to an entrance and exit wound, and is a severe type of eye injury.

Blowout fracture of the orbit is caused by blunt trauma, leads to fracture of the floor or medial wall of the orbit due to increased pressure on the orbital contents.

Fracture of the orbital bones can lead to entrapment of muscles that may limit gaze in one direction.

Assessment examination may require a topical anesthetic in order to be tolerable, and it determines if

the eye injury is a true emergency, urgent or semi-urgent.

Foreign bodies in the eye are usually classified as intraocular (IOFB) or extraocular (EOFB).

Adnexal foreign bodies in the orbit, lids, conjunctiva and lacrimal apparatus also occurs.

Chemical burns of both the conjunctiva and cornea are emergencies that require immediate treatment.


Corrosive substances are most hazardous to eyesight. 


A drop of a corrosive may cause blindness within 2–10 seconds through opacification or direct destruction of the cornea.

Penetrating globe injuries, corneal abrasions or corneal foreign bodies, hyphema, deep eyelid lacerations, radiant energy burns snow blindness require treatment urgently, within hours.

Orbital fractures and subconjunctival hemorrhages can be treated within 1-2 days.

The management for chemical eye injuries is copious irrigation of the eye with an isotonic saline or sterile water.

Patching simple corneal abrasions may not improve healing or reduce pain.

Pressure patching in a patient with a history of contact lens wear is associated with an increased risk of Pseudomonas aeruginosa.

With globe penetration, a shield patch should be applied as it protects the eye without applying any pressure.

If a shield patch is applied it should also be applied to the other eye, as uninjured eye moves, the injured eye will also move involuntarily possibly causing more damage.

Eyeglasses related injuries do occur, but prescription eyeglasses and non-prescription sunglasses offer protection resulting in a lower incidence of severe eye injuries.



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