Ocular Trauma

Ocular trauma refers to injury to the eye or surrounding structures. Eye injuries range from minor corneal abrasions that heal quickly to severe injuries that threaten vision. Prompt and appropriate response can be critical in preserving vision.

Types of Eye Injuries

Corneal Abrasion

• Scratch on the cornea (front clear surface)
• Very painful
• Tearing and light sensitivity
• Usually heals in 1-3 days
• Risk of infection if not properly treated

Foreign Body

Superficial:

• Debris on eye surface or under eyelid
• Sand, dust, eyelash, metal
• May be removable with irrigation

Embedded/Penetrating:

• Object embedded in cornea or eye
• Requires professional removal
• High-speed particles especially dangerous

Chemical Injury

Alkali burns (lye, drain cleaner, cement):

• Most severe
• Penetrate deeply into eye tissue
• Can cause devastating damage

Acid burns (battery acid, pool chemicals):

• Generally less severe than alkali
• Still require immediate irrigation and care

Blunt Trauma

• Fist, ball, airbag deployment
• Can cause:
  • Hyphema (blood in front of eye)
  • Lens dislocation
  • Retinal detachment or retinal macroaneurysm rupture
  • Orbital fracture
  • Optic nerve damage

Penetrating/Open Globe Injury

• Sharp object penetrates eye wall
• Medical emergency
• Do NOT:
  • Press on the eye
  • Remove embedded objects
  • Irrigate the eye
• Shield the eye without pressure
• Seek emergency care immediately

Orbital Fracture

• Broken bones around the eye
• Often from blunt trauma
• May cause:
  • Double vision
  • Sunken appearance
  • Numbness of cheek
  • Restriction of eye movement

Eyelid Laceration

• Cuts to the eyelid
• May need surgical repair
• Special concern if near inner corner (tear drainage)

First Aid for Eye Injuries

General Principles

• Don't rub the eye
• Don't touch the eye with dirty hands
• Don't remove embedded objects
• Don't apply pressure if eye may be penetrated
• Do seek professional care promptly

For Corneal Abrasion/Superficial Foreign Body

1. Wash hands
2. Try to flush with clean water or saline
3. Blink repeatedly
4. Don't rub
5. Seek care if persistent pain or decreased vision

For Chemical Exposure

1. Irrigate immediately and continuously
2. Use clean water, saline, or any available clean liquid
3. Hold eyelids open during irrigation
4. Continue for at least 20-30 minutes
5. Go to emergency room (continue irrigating in transit if possible)
6. Note what chemical was involved if known

For Blunt Trauma

1. Apply cold compress gently (no pressure)
2. Do not apply pressure to the eye
3. Seek medical evaluation
4. Watch for warning signs (see below)

For Penetrating Injury/Embedded Object

1. Do NOT remove the object
2. Do NOT apply pressure or rub
3. Do NOT irrigate
4. Shield the eye (cup or cardboard) without touching it
5. Seek emergency care immediately
6. Keep both eyes still (eyes move together)

When to Seek Emergency Care

How Eye Injuries Are Evaluated

Examination

• Visual acuity testing
• External inspection
• Slit-lamp examination
• Pupil assessment
• Eye pressure measurement (if safe)
• Dilated fundus exam (if indicated)

Imaging

• CT scan for orbital fractures or suspected foreign body
• Ultrasound if view into eye is blocked
• X-ray for metallic foreign bodies

Treatment by Injury Type

Corneal Abrasion

• Antibiotic drops or ointment
• Pain management
• Follow-up to ensure healing
• Usually heals in 24-72 hours

Foreign Body

• Professional removal
• Antibiotic prophylaxis
• Tetanus update if needed
• Monitoring for infection

Chemical Injury

• Continued irrigation
• pH testing until normalized
• Possible hospital admission
• Long-term follow-up for complications
• May need surgery in severe cases

Hyphema (Blood in Eye)

• Bed rest with head elevated
• Avoid blood thinners
• Daily monitoring initially
• Watch for pressure elevation
• May need surgery if severe

Open Globe/Penetrating Injury

• Shield eye (no pressure)
• IV antibiotics
• Tetanus update
• Emergency surgery
• Avoid straining, coughing, bending

Orbital Fracture

• Observation for mild cases
• Surgical repair if:
  • Significant double vision
  • Eye position affected
  • Large fracture

Prevention

90% of eye injuries are preventable with proper eyewear:

Protective Eyewear Recommendations

• Work: Safety glasses/goggles for construction, manufacturing, laboratory
• Sports: Sport-specific protective eyewear (polycarbonate)
• Home: Safety glasses for yard work, power tools, cleaning chemicals
• Children: Supervise activities, appropriate safety eyewear

High-Risk Activities

• Power tool use
• Yard work (mowers, trimmers, chainsaws)
• Sports (basketball, racquet sports, baseball)
• Working with chemicals
• Grinding, hammering, drilling
• Fireworks

Frequently Asked Questions

How do I know if my injury is serious?

Assume any significant eye injury is serious until evaluated by a professional. Vision changes, severe pain, blood in the eye, or high-speed impact all warrant immediate evaluation.

Can I sleep with an eye injury?

For minor corneal abrasions, you can sleep. Your doctor may recommend an ointment at bedtime. For more significant injuries, follow your doctor's specific instructions.

How long does a scratched cornea take to heal?

Most minor corneal abrasions heal within 24-72 hours. Larger abrasions may take longer. Contact lens-related abrasions may need extra care due to infection risk.

Will I need surgery for an eye injury?

Many injuries heal without surgery. Surgery may be needed for penetrating injuries, some orbital fractures, severe lacerations, or retained foreign bodies. Your ophthalmologist will determine what's needed.

Should I use eye drops after an injury?

Don't use drops or ointments without professional guidance, especially if there's any chance of penetrating injury. Your doctor will prescribe appropriate medications.

Can I wear contacts after an eye injury?

Wait until fully healed and cleared by your eye doctor. Contacts can increase infection risk with open wounds.

References