In the United States in 2001, an estimated 1,990,872 (6.98 per 1000 population) individuals experienced an eye injury requiring treatment in an emergency room, inpatient or outpatient facility, or private physician’s office. (McGwin G, Xie A, Owsley C. Rate of Eye Injury in the United States. Arch Ophthalmol. 2005;123:970-976.)
In persons under 25 years of age, ocular trauma is the number one cause of visual loss. Fortunately, advances in microsurgical techniques over the past decade have allowed vision to be saved in some of these injured eyes.
Injuries involving the eyelids can be serious because the eyelids protect the eyes and keep them moist, acting like windshield wipers to wash away foreign matter. An injured eyelid can lose its ability to cover the eye adequately, resulting in drying of the eye, infection, or clouding of the normally clear cornea. After trauma, the eyelids may swell dramatically. A black eye results from blood collecting beneath the loose skin of the eyelids. The tear ducts, which lead from the eyes to the nose, may also be damaged by trauma to the eyelid. Injury to the tear duct interrupts the normal drainage of tears. Propper surgical repair is necessary to maintain normal eyelid function and tear drainage.
A common eye injury requiring medical care is a scrape of the outer surface of the eye known as a corneal abrasion. Fingernails, contact lenses, and paper edges frequently cause abrasions. Corneal abrasion may also be caused by airborne particles that strike the eye during drilling, hammering, or working with cars. These kinds of injuries tend to be quite painful, usually prompting immediate eye examination. Evaluation consists of viewing the eye under a special microscope. Treatment involves removal of the foreign body (if present), instillation of antibiotics, and patching of the eye. Close observation of the eye at regular intervals is then necessary to monitor for infection.
One of the most serious injuries of the eye is a chemical burn. Damage can be minor and temporary (e.g., from hair spray) or severe and possibly blinding (e.g., from alkalis and acids). Many household products, such as drain and floor cleaners, contain alkali and should be used with extreme caution and be kept out of the reach of children. The leading cause of acid burns is an exploding car battery. When a chemical injury occurs, the eyes should be flooded immediately for ten minutes with any neutral fluid available (e.g., water or soda pop) to minimize the damage. After irrigation, emergency medical care should be sought at once.
Blunt and penetrating trauma are both significant causes of visual loss. Blunt trauma, the more common of the two, occurs when the eye is struck with a finger, fist, racket, tennis ball, or other solid object. Such injuries produce damage to the eye as a result of the sudden compression and indentation of the globe that occurs at the moment of impact. Bleeding may occur in the front of the eye between the clear cornea and colored iris, a condition referred to as a hyphema. The normally clear lens may also be damaged. It may turn cloudy, thus forming a cataract that blocks light from getting to the back of the eye, or it may be displaced within the eye so that is can no longer focus a clear image.
Blunt trauma can damage the retina, the delicate structure lining the back of the eye that receives light like the film in a camera. Vision is reduced whenever that portion of the retina responsible for sharp central vision is affected, such as when a tear in the retina leads to a large retinal detachment. Retinal detachments generally require prompt surgical repair to prevent or minimize serious visual loss. Sometimes, the effects of an eye injury may not become evident for months or years after the injury occurs. These late effects, including cataract, retinal detachment, or glaucoma (abnormally high pressure inside the eye), all may result in visual loss. Therefore, continued follow-up care is important to preserve vision after an injury.
Penetrating trauma refers to injuries in which the eye is pierced by a sharp object such as a knife, or by a high-velocity missile such as a piece of metal or a BB pellet. Surgery is often needed to repair the damage. After any penetrating eye injury, a serious intraocular infection may develop that can rapidly lead to permanent blindness in that eye. The advent of modern microsurgical techniques and the development of new antibiotics have improved the chances of saving many of these severely injured eyes.
Many eye injuries can be prevented if protective eyewear is used at work or during sports activities. If an injury does occur, prompt first aid may greatly improve the chances of preserving vision. Injuries involving chemicals such as alkalis and acids require immediate irrigation of the eye with neutral solution. For injuries from foreign bodies or from blunt or penetrating objects, a protective shield should be placed over the eye. In all cases emergency care should be quickly sought.
The Eye Trauma Center of the University of Illinois at Chicago specializes in the treatment of sight-threatening injuries. Based at the Illinois Eye & Ear Infirmary, the Center is staffed and equipped to treat eye emergencies. In cases of multiple injuries, care is also available at the University of Illinois from specialists in all types of emergencies.
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