This article is the second of two articles about traumatic eye injuries.
The first is called Basics of Eye Trauma with Emergency Pathologies and covers the relevant anatomy, history, examination and emergency sight-threatening pathologies. The pathologies discussed in this article are important to identify but are less of an emergency.
Corneal abrasion
Please refer to Red Eye article
- Very common with ocular trauma
- Superficial corneal epithelial defect
- Seen with the use of fluorescein drops and a cobalt blue light (Figure 6)
- Symptoms: eye redness, pain, watering, photophobia
Figure 1: Vislisel & Chan 2019
Key aspects of management:
- Refer if non-healing, recurrent or large abrasions (> 50% of the cornea) to ophthalmology
- Prescribe chloramphenicol ointment QDS for 5 days
Periocular haematoma
- A “black eye” which has bruising and/or periocular oedema
- Commonly due to blunt injury
Important: rule out orbital roof fracture (subconjunctival haemorrhage without a visible posterior limit may be an indicator) and basal skull fracture
Key aspects of management:
- Supportive unless there is further pathology
- Treat underlying cause if required
Eyelid lacerations
- Most commonly from sharp objects, dog bites, falls and handlebars in children and blunt trauma in adults including fists, road traffic accidents, ball sports and eye gouging.
- Evert the lid to examine the inside of the eyelid
- Think about whether the lid margin, lacrimal system or periorbital skin is involved
- Partial or full-thickness lacerations are possible
Key aspects of management:
Urgent consultation with an ophthalmologist or surgeon with cosmetic expertise for eyelid repair if any of the following:
- Suspected open globe or intraocular foreign body
- Full thickness laceration of the eyelid
- Laceration with orbital fat prolapse
- Laceration through the lid margin
- Laceration involving the tear drainage system
- Laceration with poor alignment and/or avulsion
Blow-out/orbital floor fracture
- Fracture of the orbital floor is common when facial fractures are present. In this injury, there is a fracture of the orbital floor and the inferior orbital rim remains intact.
- Symptoms: pain, periorbital ecchymosis, oedema +/- subcutaneous emphysema, infraorbital nerve anaesthesia, diplopia, enophthalmos and globe damage.
- The “teardrop sign” is a radiological sign of inferior orbital wall fractures in which intraorbital fat +/- inferior rectus muscle herniates through the fracture.
- Children may have minimal soft-tissue signs
- Cause: sudden increase in orbital pressure secondary to an incoming object causing fracture in the thin bone on the floor of the orbit. May involve facial bones.
Figure 2 – Teardrop sign (Cobb et al 2008)
Key aspects of management:
- CT scan
- Specialist input may include surgery, steroids, antibiotics, nasal decongestants and ice packs.
- Analgesia
Corneal foreign bodies
Please see Removal of foreign body from eye article
Written by Dr Sarah O’Beirne (FY3)
Corrections, additions & checking by Miss Emily Stedman (ST6 in Ophthalmology) & Ms Jennifer Tan (Consultant Ophthalmologist)
References
Bickle I, Evangelou K, Botz B, et al. Teardrop sign (inferior orbital wall fracture). Reference article, Radiopaedia.org (Accessed on 26.09.23) https://doi.org/10.53347/rID-84923
Blackburn et al. (2012) The epidemiology of chemical eye injuries. Curr Eye Res. 37(9):787-93
Cobb, Murthy, Saiet et al (2008) The tear-drop sign: a trap door for the unwary? British Journal of Oral and Maxillofacial Surgery. 46(7); 605-606
Gardiner (2022) Overview of eye injuries in the emergency department. UpToDate. < https://www.uptodate.com/contents/overview-of-eye-injuries-in-the-emergency-department>
Kanski and Bowling (2013) Synopsis of Clinical Ophthalmology, Third Edition
Kaur et al. (2020) Red Eye. Mind the Bleep. Accessed on 27.09.22 < https://www.mindthebleep.com/red-eye/>
Langer (2023) Orbital floor fractures. EyeWiki American Academy of Ophthalmology. Accessed on 14.08.23 <https://eyewiki.aao.org/Orbital_Floor_Fractures>
Murchison et al. (2022) Eyelid laceration. Eye Wiki, American Academy of Ophthalmology. Accessed on 14.09.22 < https://eyewiki.aao.org/Eyelid_Laceration>
Patel et al. (2021) Ocular trauma: acute evaluation, cataract, glaucoma. EyeWiki, American Academy of Ophthalmology. Accessed 30.09.23 <https://eyewiki.aao.org/Ocular_Trauma:_Acute_Evaluation,_Cataract,_Glaucoma>Vislisel & Chan (2019) Corneal abrasion. Ophthalmology and Visual Sciences, The University of Iowa. Accessed on 27.09.22 < https://webeye.ophth.uiowa.edu/eyeforum/atlas/pages/corneal-abrasion/index.htm>
