Eye injuries

• Eye injuries may be of different types: closed globe injuries (blow or contusion caused by a blunt object) or penetrating injuries (caused by a perforating object). Chemical products may also cause them when in contact with the eyes.
• Eye contusions may lead to cataracts, glaucoma, inflammations, haemorrhages, and retinal or choroid tears or ruptures. In up to 5% of the cases, an eye contusion causes a retinal detachment.
• In case of perforations, there is a risk of infection, as a foreign body may remain inside the eye, thus leading to a worse prognosis. In most severe cases, the eyeball integrity may be endangered.
• Treatments are various and go from the use of eye drops in small corneal erosions or scratches, to complex surgical interventions in the most severe eye perforation cases.
• The most common causes of eye injuries are work accidents, home accidents (up to a 50%), traffic accidents, assaults and accidents from sport practice.

Eye injuries may be caused by several causes, from blows and contusions at a high speed with blunt objects to perforations caused by penetrating objects or burns caused by chemical products Treatments will vary depending on the type of injury, and may include from antibiotic eye drops to complex surgical interventions.

Caused by a perforating object

Caused by a blunt object

There are two types of eye injuries: closed globe injuries and penetrating injuries.

What is a closed globe injury?

A closed globe injury is an eye contusion, and is caused by a blunt object, such as a padel, tennis or golf ball, that hits at a high-speed the eye surface and may damage several structures.

Damages may include:

• Iris sphincter ruptures, which is the rupture of the muscle in charge of pupil contraction. In patients suffering such rupture, the pupil may remain dilated or deformed for life, which may cause permanent discomfort to light, known as photophobia.
• Inflammations or uveitis.
• Very high ocular pressure peaks that may even damage the optic nerve and cause glaucoma.
• Some patients may also suffer from a cataract, secondary to this kind of injury, and such cataract may fall into the retinal cavity. This phenomenon is known as lens luxation.
• Haemorrhages or bursts within the eye.
• Choroid ruptures. The choroid is the layer located behind the retina.
• Tears and ruptures in the most peripheral area in the retina, and holes in its central area, known as macula, which is the area of maximum vision.
• Retinal detachment, in up to a 5% of patients with eye contusions.

What is a penetrating eye injury?

A penetrating eye injury is what we known as an eye perforation. In such cases, there is a loss of continuity of the eye globe, that may cause its content to leak out. These are very serious cases that require urgent interventions, and in which foreign bodies may even be present within the eye. Therefore, the infection risk is very high. Most of these patients end up suffering a substantial vision loss.

This kind of eye injury has a particularly negative impact in pediatric population: it represents the main cause of monocular blindness in children. Furthermore, pediatric patients with penetrating eye injuries present a course with more more complication than adults.

Besides the young age, there are several risk factors for a worse prognosis: prior poor visual acuity, a posterior affectation, a wide injury, a vitreous hemorrhage, a retinal detachment and endoftalmitis. In order to improve visual prognosis, it will be specially important the cooperation of the patient, which can be challenging in these cases, and going to the emergency room as soon as possible.

Eye injuries are very frequent in ophthalmology emergency rooms. The typical profile of a patient suffering from an eye injury is a young adult of working age, between 20 and 40 years old. Moreover, several activities are related to the occurrence of such injuries.

• Work accidents
• Home accidents (which account for 50% of the cases)
• Traffic accidents
• Assaults
• Sports activities
• In pediatric patients, games with different objects such as sticks, toys with projectiles and fireworks.

Visual acuity in such patients will depend on the type of injury. In some patients, vision is almost unaffected. In some others, loss of visual acuity may be very serious and irreversible, even reaching the levels of legal blindness.

In some cases, where there is an eyeball rupture, which is a very serious injury, the patient may even lose the eye and require an eye implant or prosthesis, known as artificial eye.

It is essential that any patient that suffers from an eye injury goes to the ophthalmology emergency room in order to undergo a comprehensive examination including visual acuity, ocular pressure and eye fundus under dilation.

In some patients, due to means opacity, a huge inflammation or an haemorrhage, the retina may not be visible, reason why additional tests, such as ultrasounds, must be performed in consultation, in order to assess the state of the retina.

In some cases, an ocular CT scan may be even necessary in order to rule out a possible orbital bones fracture, or fracture of bones that surround the eyeball, as well as to confirm there are no injuries in muscles, or even rule out the presence of a foreign body within the eye.

The treatment of eye injuries will depend on the type of injury:

• Some patients come to the consultation with corneal erosions or eye scratches, which are small wounds in the cornea, the anterior part of the eye. This kind of wound usually responds to treatment with eye drops or antibiotic drops.
• In cases where there is an eye inflammation (uveitis), topical anti-inflammatory treatments or even oral cortisone may be administered.
• Some patients also come to the consultation with burns or injuries caused by chemical products (such as bleach). In such cases, when at home, the eyes must be washed with water urgently, and at the consultation a proper wash with a physiological saline solution must be performed for some minutes in order to try to eliminate the chemical agent.
• Patients can also come to the consultation suffering from haemorrhages that doesn’t resolve or with a retinal detachment that will require surgical treatment.
• Eye injuries may also cause high peaks in ocular pressure. In such cases, a specific treatment to lower ocular pressure and avoid damages in the optic nerve will be administered.
• Holes in the peripheral area of the retina may also occur. In such case, a laser session may be performed in the consulting room.
• In the most severe cases, such as the above-mentioned eye perforation cases, an urgent surgical intervention will be performed, due to the high risk of infection and of eye loss, besides the bad visual prognosis.