Blunt Trauma to the Eye

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Have you sustained a direct blow to the eye by a clenched fist, a ball, or champagne cork? Then you have experienced Blunt Trauma or Contusion Injury to your eye.

Is Blunt Trauma to the eye common?

Various statistics on this occurrence will help you put your injury in perspective.

2.5 million ocular/orbital injuries occur annually

40,000 individuals are left with some permanent visual impairment

1,500 lose sight permanently

Males outnumber females in these types of injuries 4:1

What types of injuries can Blunt Trauma cause to the eye?

Periorbital Ecchymosis: In the event of Blunt Trauma, the lids will swell in an exaggerated manner as a protective mechanism for the eye.

Also, there may be accumulation of blood (usually in the lower lid) from ruptured blood vessels as a result of the impact. In order to reduce swelling, cold compresses (e.g., ice packs) in the first 48 hours is recommended.

Lid laceration: The object striking the eye in the case of Blunt Trauma may be jagged and can therefore cause superficial to deeper cuts on the lid. You should go to your eye doctor for treatment, especially because you cannot be sure if any damage was done to the eye itself.

Your doctor will clean and irrigate the wound and the surrounding skin thoroughly. Any remaining foreign material should be removed (e.g., glass pieces, metal fragments, etc.) Antibiotic ointment and sterile dressing should then be used. Of course if the lacerations are deeper, your doctor may have to suture them.

Subconjunctival Hemorrhage can appear quite alarming after Blunt Trauma. It is essentially a bruising of the eye where there is an accumulation of blood in the space between the conjunctiva and the sclera. The conjunctiva is the clear tissue covering the white part of the eye, or sclera.

More often than not, Subconjunctival Hemorrhage is benign and does not require any further treatment except for lubricating drops for comfort. The use of elective (i.e., not prescribed by a doctor) blood thinners like aspirin should be discontinued to minimize excessive bleeding.

Conjunctival Abrasion or Laceration: The conjunctiva, as a result of a jagged object, can also sustain an abrasion or deeper cut (laceration). If the cut is so deep that there is exposed sclera and the lesion is greater than 1 to 1.5 cm, then sutures may be used. Antibiotic ointment for 3-7 days will be prescribed and pressure patching will be used for the first 24 hours.

Corneal Abrasion: The transparent tissue covering the iris (the colored part of the eye) may also get scratched from Blunt Trauma with a jagged object. Usually instead of a pressure patch, a bandage contact lens is used to minimize rubbing of the open would with the blinking lid without obstructing vision like a patch does.

Corneal or Conjunctival Foreign Bodies: These foreign bodies should be removed by your eye doctor as much as possible provided that excessive damage to the eye is not done. In the case of metallic foreign bodies, rust usually has to be “drilled” out of the cornea.

Corneal Laceration: This occurrence can be very serious since the globe can be ruptured with potential open communication between the inside of the eyeball and the outside environment. Of course the risk of infection needs to be watched carefully. Superficial and small lacerations can be treated like Corneal Abrasions, but deeper lacerations should be sutured.

Hyphema: The accumulation of blood in the anterior chamber (the fluid-filled space between the cornea and the lens of the eye).

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Minor cases may be managed in an outpatient basis:

Compliant adults who will be able to rest quietly at home (with no young children to care for)

Patients that have no blood disorders like sickle cell disease or trait.

A hyphema measuring less than 1/3 of anterior chamber

Eye pressure of less than 35 mm Hg

All others require hospitalization and approximately 5-10% of traumatic hyphemas require surgical intervention.

Other facts to remember about Hyphema:

~25% rebleed

~30% have a temporary eye pressure elevation for five to seven days

~75% demonstrate some degree of damage to the angle of the eye in the anterior chamber such as angle recession or iridodialysis (which is a localized tearing away of the iris from its attachment to the ciliary body)

~5% will develop secondary glaucoma

Anterior Uveitis (or Traumatic Iritis): This condition is marked by inflammatory cells and leaked proteins into the anterior chamber of the eye. It is managed by reducing inflammation, preventing scarring and minimizing damage to the uveal blood vessels.

Your eye doctor will begin treating this condition aggressively by prescribing steroid eye drops to be used every hour to two hours, depending on the severity of the presenting inflammation.

Traumatic Cataract or dislocation of the crystalline lens of the eye. The Traumatic Cataract is usually a white, star-shaped opacity. Lens dislocation is referred to Lens Subluxation. The crystalline lens of the eye is suspended behind the iris by zonules, or elastic fibers. As a result of Blunt Trauma, these zonules can be torn and the lens dislocated from its position.

If this condition does not create visual problems, your eye doctor will still need monitor you. If you do have complaints, more than likely surgical intervention will be necessary.

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Ruptured Globe: This is dangerous because of the risk of infection resulting from the open communication between the eye contents and the outside environment. Also, the risk of an object having flown into the eye exists and thus a CT scan should be done to identify any intraocular or intraorbital foreign body.

Sadly, if the eye cannot see light or is severely traumatized, it should be removed (enucleated) within 7-14 days to avoid Sympathetic Ophthalmia. Sympathetic Ophthalmia is a visually devastating, rare autoimmune disease in which a penetrating injury to one eye produces inflammation in the uninjured eye which can lead to gradually progressive loss of vision.

Blowout Fracture: This refers to a fracture of the orbital floor or nasal wall. Eye movements may reveal restriction of movement due to entrapment of a muscle in the fractured site. If there is decreased sensation of the cheeks or upper lip, there may also be nerve impingement. CT scan is necessary and surgical intervention may be needed, especially in the pediatric population.

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Retinal damage: Blunt Trauma can affect the retina in many ways, ranging from temporary whitening from the force of the impact (referred to as Commotio Retinae) to hemorrhages, or even to the risk of getting a foreign material lodged in the back of the eye. In some cases, Blunt Trauma can cause Retinal Detachment, which requires surgical intervention.

What should you do if you or your child experiences an eye injury?

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As you can see from this brief discussion, serious injury to the eye requiring hospitalization and/or surgical intervention can result from Blunt Trauma.

If you or a loved one sustains an eye injury, going to your eye doctor immediately is critical. There may be damage to the eye that you may not be able to see.

Also, if you or your loved one sustains a penetrating eye injury where an object is impaled in the eye, DO NOT PULL IT OUT OF THE EYE! Use a cup to shield the eye and report immediately to an eye surgeon. By pulling out an object impaled in the eye, you may cause more permanent damage.

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