Eye trauma

Blunt Trauma

Orbital fracture: Presents with pain, diplopia, restricted eye movement, and possible enophthalmos or infraorbital nerve anesthesia
Retinal detachment: Sudden onset of floaters, flashes of light, and a shadow or curtain across the visual field
Traumatic iritis: Pain, photophobia, blurred vision, and ciliary flush following trauma
Hyphema: Blood in the anterior chamber, often associated with blunt trauma; may cause pain, blurred vision, and photophobia
Commotio retinae: Transient retinal whitening with visual disturbance after blunt trauma, typically resolves without intervention
Vitreous hemorrhage: Presents with sudden vision loss or floaters, commonly seen in association with retinal tears or detachment
Globe rupture: Severe eye pain, visual loss, and often a teardrop-shaped pupil with an obvious wound
Lens dislocation: Can cause monocular double vision, visual disturbances, and possibly secondary glaucoma

Penetrating Trauma

Corneal laceration: Pain, tearing, and photophobia with a visible cut on the cornea; risk of infection and scarring
Scleral laceration: Similar symptoms to corneal laceration but may involve deeper structures and can lead to globe rupture
Intraocular foreign body: Persistent pain, tearing, and reduced vision; requires urgent removal to prevent infection and further damage
Globe rupture: Pain, decreased visual acuity, and visible deformity of the globe with possible extrusion of intraocular contents
Endophthalmitis: Inflammation of the internal coats of the eye due to infection, often following penetrating trauma; presents with pain, redness, and reduced vision
Retained intraocular foreign body: May present with chronic inflammation or recurrent episodes of pain and vision loss
Secondary glaucoma: Increased intraocular pressure following trauma, leading to pain and visual loss
Sympathetic ophthalmia: Rare, bilateral granulomatous uveitis following penetrating injury to one eye

Chemical and Thermal Injuries

Chemical burns: Severe pain, redness, tearing, and possible vision loss depending on the severity and the chemical involved; alkali burns are particularly serious
Thermal burns: Pain, redness, and possibly charring of the eyelids and surrounding tissues; may lead to corneal damage and vision loss
Photokeratitis: UV light exposure (e.g., welding without eye protection) causing pain, redness, tearing, and photophobia
Radiation injuries: Can cause delayed effects such as cataract formation or chronic dry eye symptoms depending on exposure
Acute keratoconjunctivitis: Inflammation due to UV exposure, presents with pain, photophobia, and tearing
Stevens-Johnson syndrome: Severe mucocutaneous reactions can involve the eyes, causing pain, redness, and possible vision loss
Chronic effects: Scarring, symblepharon (adhesion of the eyelid to the eyeball), and chronic dry eye symptoms

Mechanism of Injury

Blunt vs penetrating: Helps to determine the potential for globe rupture or other serious injuries
Chemical exposure: Identify the substance involved, duration of contact, and any first aid measures taken
Thermal exposure: Source of heat and duration of exposure to assess potential for burns and deeper tissue damage
High-velocity injuries: Suggests a higher risk of intraocular foreign body or penetrating trauma
Work-related injury: Consider safety measures in place, such as the use of protective eyewear
Symptom progression: Sudden worsening of symptoms may indicate complications such as secondary glaucoma or retinal detachment

Associated Symptoms

Visual loss: Sudden or progressive loss of vision can indicate serious injury such as globe rupture, retinal detachment, or optic nerve damage
Photophobia: Common in corneal injuries, uveitis, or retinal damage
Pain: Severity and nature of pain can help differentiate between conditions like corneal abrasion (sharp pain) vs uveitis (dull ache)
Discharge: Purulent discharge may suggest an associated infection, particularly in the context of penetrating trauma
Diplopia: May indicate orbital fracture, muscle entrapment, or cranial nerve injury
Systemic symptoms: Fever, headache, or nausea may suggest associated conditions like endophthalmitis or orbital cellulitis

Background

Past medical history: Previous eye conditions or surgeries may predispose to complications or influence management decisions
Medication history: Use of anticoagulants, which may increase the risk of bleeding in the event of trauma
Family history: Any history of eye diseases or bleeding disorders that could complicate management
Social history: Occupation, hobbies, or activities that may increase the risk of eye trauma or inform prevention strategies
Surgical history: Previous ocular surgeries that could impact the assessment and management of the trauma

Initial Examination

Visual acuity: Assess for any loss of vision, which can indicate the severity of the injury
Pupil reaction: Check for afferent pupillary defect (Marcus Gunn pupil) which can suggest optic nerve or retinal damage
Slit-lamp examination: Essential for evaluating the anterior segment, detecting corneal abrasions, lacerations, foreign bodies, or hyphema
Intraocular pressure measurement: Elevated pressure may indicate secondary glaucoma or globe rupture (contraindicated if globe rupture is suspected)
Fundoscopy: To assess the retina and optic nerve, particularly in suspected retinal detachment or vitreous hemorrhage
Fluorescein staining: To detect corneal abrasions, lacerations, or leaking wounds indicating globe rupture
Seidel test: Used during fluorescein staining to detect leaking aqueous humor from a corneal or scleral wound
Ocular motility: Assess for restricted movement that might suggest orbital fractures or muscle entrapment

Imaging and Specialist Tests

Orbital X-ray: To detect fractures, foreign bodies, or other structural abnormalities
CT scan of the orbits: Preferred imaging for orbital fractures, globe rupture, and detection of foreign bodies
MRI: Used in cases where soft tissue detail is crucial, but generally avoided in suspected metallic foreign body cases
Ultrasound (B-scan): Useful for assessing retinal detachment, vitreous hemorrhage, or intraocular foreign bodies when the view is obscured
Anterior segment OCT: High-resolution imaging of the cornea and anterior chamber for detailed assessment in complicated cases
Electroretinography (ERG): May be considered in cases of suspected retinal dysfunction following trauma

Emergency medicine and intensive care