Ocular trauma: Look out for these findings when treating patients’ eye injuries

Chances are high that someone experiencing an eye injury will walk through your exam room: 19 million people suffer from ocular trauma-related blindness or low vision globally. In the United States, 2.0 to 2.4 million cases of ocular trauma—with many progressing to permanent vision loss—are estimated to occur annually.

At VisualDx, we want to make sure you are equipped with the information you need when you need it so that you can effectively diagnose, treat, and manage your patients’ ocular traumas—which is why we have more than 8,000 eye-related diagnoses.

Ophthalmologist Rachel Wozniak, MD, PhD, shares with us the four most common types of ocular trauma and when you should be concerned.

Metal working (car, machinery), workplace industrial materials (construction), wood working, yard work (branches, thorns, debris from lawn mower), fishhooks

• Findings: Varies based on size and velocity of object. Eyelid lacerations, corneal abrasions, corneal / scleral lacerations, conjunctival lacerations, subconjunctival hemorrhage, leaking of aqueous fluid (positive Seidel sign), intraocular foreign bodies, extrusion of intraocular contents, traumatic cataract, retinal detachment, retinal tear, vitreous hemorrhage, full penetration of a foreign body through the cornea / sclera into the eye, and an exit wound in the posterior wall of the eye.
• Concerning findings: 360° subconjunctival hemorrhage, flat anterior chamber, aqueous fluid leakage, complete loss of vision, retinal detachment
• Workup: CT imaging of head / orbits, possible ocular ultrasound (B-scan), full eye exam
• Management: Tetanus up to date, IV antibiotics, plan for urgent surgery to remove the object and repair the globe, if necessary. Other treatment modalities for minor injuries range from topical antibiotics, topical steroids, topical cycloplegia, lubrication, bandage contact lens, observation.

Sports injuries (eg, basketball, baseball, softball, soccer, etc.), altercations / assaults, motor vehicle accidents

• Findings: Vary based on size and velocity of impact. Periocular swelling and bruising, orbital fractures, traumatic iritis, traumatic optic neuropathy, hyphema, iridodialysis, cataract, lens dislocation, ruptured globe, retinal commotio, retinal detachment, vitreous hemorrhage.
• Concerning Findings: Complete loss of vision, retinal detachment, lens dislocation, ruptured globe
• Workup: CT imaging of head/orbits, possible ocular ultrasound (B-scan), full eye exam
• Management: Ranges from surgical intervention for major orbital fractures, lens dislocation, ruptured globe, and retinal detachment to more conservative treatment modalities, including topical antibiotics, topical steroids, topical cycloplegia, lubrication, bandage contact lens, and observation.

#3. Eye Injuries Caused by Sun Exposure

Injury caused by looking directly at the sun

• Findings: Solar keratitis (corneal burn), solar retinopathy (retinal burn)
• Concerning findings: Loss of vision
• Workup: Full eye exam, retinal optical coherence tomography (OCT) scan
• Management: For corneal burns: lubrication, topical antibiotics, bandage contact lens. For retinal burns there is no treatment.

Home fireworks (heat/chemical burn), industrial accidents (chemical burn), cleaning products / bleach (chemical burn)

• Findings: Corneal abrasions, blanching (whitening) of the sclera, loss of eyelashes, clouding of the cornea
• Concerning findings: Limbal blanching, full corneal involvement
• Workup: Check pH, full eye exam
• Management: Possible flushing the ocular surface with saline, topical lubrication, topical antibiotics, amniotic membrane, doxycycline, vitamin C

Rachel Wozniak, MD, PhD, is a member of the Flaum Eye Institute’s Cornea Service. She provides expert and compassionate medical and surgical care to patients challenged by hereditary and infectious corneal disease, anterior segment injuries, complications of systemic disease, cataract, and ocular surface disease.