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| {{SI}} | | __NOTOC__ |
| | {{Eye injury}} |
| | '''For patient information, click [[Eye injury (patient information)|here]]''' |
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| {{CMG}} | | {{CMG}} {{AE}} {{SME}} |
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| | ==[[Eye injury overview|Overview]]== |
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| | ==[[Eye injury classification|Classification]]== |
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| ==Overview== | | ==[[Eye injury pathophysiology|Pathophysiology]]== |
| [[Physiology|Physical]] or [[chemical]] injuries of the [[eye]] can be a serious threat to [[Visual perception|vision]] if not treated appropriately and in a timely fashion. The most obvious presentation of ocular (eye) injuries is redness and [[Pain and nociception|pain]] of the affected eyes. This is not, however, universally true, as tiny [[metal]]lic projectiles may cause neither symptom. Tiny metallic projectiles should be suspected when a patient reports ''metal on metal'' contact, such as with hammering a metal surface. Intraocular foreign bodies do not cause pain because of the lack of [[nerve ending]]s in the [[vitreous humour]] and [[retina]] that can transmit pain sensations. As such, general or [[emergency room]] [[Physician|doctor]]s should refer cases involving the [[posterior segment]] of the eye or intraocular foreign bodies to an [[ophthalmologist]]. Ideally, ointment would not be used when referring to an ophthalmologist, since it diminishes the ability to carry out a thorough [[eye examination]]. | |
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| ==Causes== | | ==[[Eye injury causes|Causes]]== |
| Flying pieces of wood, metal, glass, stone and other material are notorious for causing much of the eye trauma. Blunt injury by fist (during a drunken brawl), ball (cricket ball, lawn tennis ball), shuttle cock (from Badminton) and other high speed flying objects can strike the eye. Small children may indulge in bow-and-arrow games and firecrackers (respectively common during Dussehra and Diwali festivals in India) which can lead to eye trauma. Road traffic accidents (RTAs) with head and facial trauma may also have an eye injury - these are usually severe in nature with multiple lacerations, shards of glasses embedded in tissues, orbital fractures, severe hematoma and penetrating open-globe injuries with prolapse of eye contents. Other causes of intraocular trauma may arise from workplace tools or even common household implements. <ref name="Feist">Feist RM, Lim JI, Joondeph BC, Pflugfelder SC, Mieler WF, Ticho BH, Resnick K. "Penetrating ocular injury from contaminated eating utensils." ''[[Archives of Ophthalmology]].'' 1991 Jan;109(1):23-30. PMID 1987951.</ref>
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| ==Effects of eye injury== | | ==[[Eye injury differential diagnosis|Differentiating Eye Injury from other Diseases]]== |
| *'''Closed globe injury''' or '''Non-penetrating trauma''': The eye globe is intact, but the seven rings of the eye have been classically described as affected by blunt trauma.
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| *'''Perforating trauma''': The globe integrity is disrupted in one place and may be associated with prolapse of internal contents of the eye.
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| *'''Penetrating trauma''': The globe integrity is disrupted in two places (through and through injury). This is a quite severe type of eye injury.
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| *'''Blowout fracture of the orbit''' is caused by blunt trauma, classically described for fist or ball injury, leading to fracture of the floor or medial wall of the orbit due to sudden increased pressure on the orbital contents.
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| ==Epidemiology== | | ==[[Eye injury epidemiology and demographics|Epidemiology and Demographics]]== |
| A recent study estimated that from 2002-2003 there were 27,152 injuries in the United States related to the wearing of [[eyeglasses]].<ref name="Sinclair">Sinclair SA, Smith GA, Xiang H. "Eyeglasses-related injuries treated in U.S. emergency departments in 2002-2003." ''Ophthalmic Epidemiol.'' 2006 Feb;13(1):23-30. PMID 16510343.</ref> The same study concluded that sports-related injuries due to eyeglasses wear were more common in those under the age of 18 and that fall-related injuries due to eyeglasses wear were more common in those aged 65 or more.<ref name="Sinclair"/> Although eyeglasses-related injuries do occur, prescription [[eyeglasses]] and non-prescription [[sunglasses]] have been found to "offer measurable protection which results in a lower incidence of severe eye injuries to those wearing [them]".<ref name="May">May DR, Kuhn FP, Morris RE, Witherspoon CD, Danis RP, Matthews GP, Mann L. "The epidemiology of serious eye injuries from the United States Eye Injury Registry." ''Graefes Arch Clin Exp Ophthalmol.'' 2000 Feb;238(2):153-7. PMID 10766285.</ref>
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| ==Investigation== | | ==[[Eye injury risk factors|Risk Factors]]== |
| The goal of investigation is the assessment of the severity of the ocular injury with an eye to implementing a management plan as soon as is required. The usual [[eye examination]] should be attempted, and may require a [[topical anesthetic]] in order to be tolerable.
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| The first step is to assess the external condition of the eye and [[orbit (anatomy)|orbit]], and check for perforations, [[hyphema]], uveal prolapse, or globe penetration. If the [[pupil]] is teardrop-shaped, and the anterior chamber is flat, this is almost always a perforating injury of the [[cornea]] or limbal area.
| | ==[[Eye injury natural history, complications and prognosis|Natural History, Complications and Prognosis]]== |
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| Depending on the [[medical history]] and preliminary examination, the primary care physician should designate the eye injury as a ''true emergency'', ''urgent'' or ''semi-urgent''.
| | ==Diagnosis== |
| | [[Eye injury history and symptoms|History and Symptoms]] | [[Eye injury physical examination|Physical Examination]]| [[Eye injury laboratory findings|Laboratory Findings]] | [[Eye injury orbital x ray|Orbital X Ray]] | [[Eye injury CT|CT]] | [[Eye injury MRI|MRI]] | [[Eye injury b scan ultrasound|B Scan Ultrasound]] | [[Eye injury other imaging findings|Other Imaging Findings]] | [[Eye injury other diagnostic studies|Other Diagnostic Studies]] |
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| ===Emergency=== | | ==Treatment== |
| An ''emergency'' must be treated within minutes. This would include [[chemical burn]]s of the [[conjunctiva]] and [[cornea]].
| | [[Eye injury medical therapy|Medical Therapy]] | [[Eye injury surgery|Surgery]] | [[Eye injury primary prevention|Primary Prevention]] | [[Eye injury cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Eye injury future or investigational therapies|Future or Investigational Therapies]] |
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| ===Urgent===
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| An ''urgent'' case must be treated within hours. This includes penetrating globe injuries; [[corneal abrasion]]s or corneal foreign bodies; hyphema (must be referred)' eyelid lacerations that are deep, involve the lid margin or involve the [[lacrimal canaliculi]]; radiant energy burns such as [[arc eye]] (welder's burn) or [[snow blindness]]; or, rarely, traumatic [[optic neuropathy]].
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| ===Semi-urgent===
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| ''Semi-urgent'' cases must be managed within 1-2 days. They include orbital fractures and [[subconjunctival hemorrhage]]s.
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| ==Management==
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| ===Irrigation===
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| The first line of management for chemical injuries is usually copious irrigation of the eye with an [[isotonic]] [[saline (medicine)|saline]] or [[sterilization (microbiology)|sterile]] [[water]]. In the cases of chemical burns, one should not try to [[buffering agent|buffer]] the solution, but instead dilute it with copious flushing.
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| ===Patching===
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| Depending on the type of ocular injury, either a ''pressure patch'' or ''shield patch'' should be applied. In most cases, such as those of corneal abrasion or the like, a pressure patch should be applied that ensures some tension is applied to the eye, and that the patient cannot open her or his eye under the patch. In cases of globe penetration, pressure patches should never be applied, and instead a shield patch should be applied that protects the eye without applying any pressure.
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| ===Suturing===
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| In cases of eyelid laceration, sutures may be a part of appropriate management by the primary care physician so long as the laceration does not threaten the canaliculi, is not deep, and does not affect the lid margins.
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| ==Complications==
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| Multiple complications are known to occur following eye injury: [[corneal]] scarring, [[hyphema]], [[iridodialysis]], post-traumatic [[glaucoma]], [[uveitis]] [[cataract]], vitreous hemorrhage and [[retinal detachment]]. The complications risk is high with retinal tears, penetrating injuries and severe blunt trauma.
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| ==References==
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| {{reflist|2}}
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| | == Case Studies == |
| | [[Eye injury case study one|Case #1]] |
| ==Related Chapters== | | ==Related Chapters== |
| *[[List of eye diseases and disorders]] | | *[[List of eye diseases and disorders]] |
| *[[Black eye]] | | *[[Black eye]] |
| *[[United States Eye Injury Registry]], which compiles statistics regarding eye injuries in the United States. | | *[[United States Eye Injury Registry]] |
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| {{visual system}} | | {{visual system}} |
| | [[cs:Poranění oka]] |
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| [[category:Primary care]]
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| [[Category:Injuries]] | | [[Category:Injuries]] |
| [[Category:Ophthalmology]] | | [[Category:Ophthalmology]] |
| [[Category:Emergency medicine]] | | [[Category:Emergency medicine]] |
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