Trauma
- The eye is well protected by bony orbit and reflex closure of the eye lid
- Corneal trauma is common
- More major injuries are rare
Corneal foreign body
- Due to fragments hitting cornea at high speed
- Often as a result of hammering or drilling
- Usually causes pain, photophobia and profuse lacrimation
- Local anaesthesia may be required in order to examine the eye
- Foreign body is often readily seen
- If present for more than a few hours is often results in a 'rust ring'
- Object can often be removed with sterile needle under local anaesthesia
- Antibiotic ointment and cycloplegic drops should be instilled into the eye
- A pad should be applied
Subtarsal foreign body
- Foreign bodies occasionally become embedded in subtarsal conjunctiva of upper lid
- Cause pain and lacrimation
- Examination may show fine, vertical linear corneal abrasions
- Eversion of the upper eyelid with a cotton bud will show the foreign body
- Can be removed with a needle
- Foreign body sensation may persist for a while
Picture provided by Paul Rowe, Gloucester Royal Infirmary, Gloucester, United Kingdom
Corneal abrasion
- Often causes by twigs, fingernails and the edges of pieces of paper
- Causes intense pain and lacrimation
- Abrasion can be confirmed with the aid of fluorescein
- Antibiotic ointment and cycloplegic drops should be instilled into the eye
- A pad should be applied
- Most abrasions heal within 48 hours
Blunt trauma
- Blunt ophthalmic trauma can result in:
- Black eye
- Subconjunctival haemorrhage
- Corneal abrasion
- Traumatic mydriasis
- Hyphaema
- Iridoialysis
- Concussion cataract
- Lens subluxation
- Retinal tear
- Vitreous haemorrhage
- Commotio retinae
- Choroidal rupture
- Blow-out orbital fracture
Hyphaema
- Bleed into the anterior chamber of the eye
- Due to rupture of the iris blood vessels
- Presents with a reduction in visual acuity
- Red reflex is lost
- Within short period of time the blood settles and produces a fluid level
- Most settle with conservative treatment
- Surgical treatment may be required if anterior chamber is full of blood ('eight-ball' hyphaema)
- Can result in glaucoma or blood-staining of the cornea
Blow-out fracture
- Posterior displacement of globe raises orbital pressure
- Orbit then fractures at its weakest point
- Usually occurs at the orbital floor
- Soft tissues herniates into the maxillary sinus
- Clinical features include:
- Enophthalmos
- Restriction of eye movement - especially on upward gaze
- Loss of sensation over region supplied by infra-orbital nerve
- Sinus x-ray shows clouding of the affected sinus
- May be able to identify herniated tissue on x-ray
- Surgical correction is often required
Penetrating injuries
- Penetrating injuries can result in:
- Corneoscleral lacerations
- Intraocular foreign bodies
- Sympathetic ophthalmitis
Intraocular foreign body
- Usually causes by metal fragment hitting eye at high speed
- Patient is usually aware of something having stuck the eye
- In early stages there is no significant visual loss
- Signs may be easily missed
- X-ray of the orbit is essential
- Foreign body may also be identified on CT or ultrasound
- Retained iron and copper foreign bodies can give rise to serious chemical reactions
- Siderosis from iron causes staining of the iris, cataract formation and retinal atrophy
- Chalcosis from copper deposition causes endophthalmitis and rapid visual loss
- Ferrous foreign bodies can be removed with a powerful electromagnet
- Non-magnetic foreign bodies should be mechanically removed
Chalazion
- Due to inflammation of the meibomian gland
- Presents as painless, hard lump close to margin of eye lid
- More common in the upper lid
- Increases in size over days or weeks
- Small lesions require no treatment
- Large symptomatic lesions can be incised and curetted
- Performed via conjunctival incision
Acute red eye
- Common causes of an acute red eye include:
- Conjunctivitis
- Keratitis
- Iritis
- Acute glaucoma
- Episcleritis
- Scleritis
Bibliography
Davy C C. The red eye. Br J Hosp Med 1996; 55: 89-94
Leibowitz H M. The red eye. N Eng J Med 2000; 343: 345-351.
MacEwan C J. Ocular injuries. J R Coll Surg Ed 1999; 44: 317-323.
Weber C M, Eichenbaum J W. Acute red eye: differentiating viral conjunctivitis from other
less common causes. Postgrad Med 1997; 101: 185 - 192. |