Updated: 10/11/2020

Common Eye Injuries

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  • A 27-year-old man presents to the emergency department after "feeling an object entering his eye" while hammering a metal nail into the wall. He reports mild discomfort in his right eye but denies any changes in his vision. On physical exam, no visual acuity deficit is appreciated. Slit-lamp examination with fluorescein staining demonstrates a small penetrating wound injury. A computerized tomography (CT) scan of the eye demonstrates a hyperdense lesion within the vitreous cavity. (Intraocular foreign body)
Eyelid Laceration
  • Definition
    • a lesion affecting the eyelid 
  • Pathogenesis
    • a blunt or penetrating injury affecting the eyelid (e.g., a child hitting their eyelid on a chair)
  • Presentation
    • physical exam
      • laceration to the eyelid 
  • Studies
    • management approach
      • the mechanism of injury must be elucidated in order to determine if there are any other accompanying injuries (e.g., globe injury and the presence of an intraocular foreign body)
    • computerized tomography (CT) scan of the eye
      • indication
        • to determine the presence of a
          • foreign body
          • globe rupture
          • orbital fracture
          • retrobulbar hemorrhage or hematoma
            • requires emergent lateral canthotomy to reduce intraoocular pressure 
  • Treatment
    • tetanus prevention
      • indication
        • in patients with eyelid lacerations
      • modalities
        • tetanus immunoglobulin
          • in patients who have never been immunized
        • tetanus toxoid
          • in patients who have not been immunized in the preceding 10 years
          • in patients who have not been immunized in the preceding 5 years and have unclean or puncture wounds
    • antibiotics
      • indication
        • in patients who have an eyelid laceration secondary to animal bites
          • proper wound irrigation is needed
      • notes
        • patients may need rabies prophylaxis
    • laceration repair
      • indication
        • in patients with an eyelid laceration
Corneal Abrasion
  • Definition
    • damage to the corneal epithelium secondary to trauma
  • Pathogenesis
    • etiology
      • trauma (physical or chemical)
      • dry eye
      • intraocular foreign body
      • contact lenses
  • Presentation 
    • symptoms
      • severe eye pain
      • photophobia
      • may mention they have a foreign body sensation in the affected eye
        • prevents the opening of the eye
  • Studies
    • management approach
      • patients should have a complete eye examination and an open globe must be ruled out
    • fluorescein staining and slit-lamp examination 
      • confirms the diagnosis
    • culture
      • very rarely performed
      • most common pathogen is coagulase negative staphylococcus 
  • Treatment
    • dependent on the cause
      • e.g., if the corneal abrasion is caused by a foreign body, the foreign body is removed
    • topical antibiotics
      • indication
        • used to address the risk of infection in patients with corneal abrasion
      • medications
        • erythromycin (ointment preferred) 
          • used in patients with corneal abrasion secondary to
            • foreign body
            • trauma
            • recurrent abrasion
        • fluoroquinolone or tobramycin
          • used in patients with corneal abrasion secondary to
            • contact lenses
Chemical Injury
  • Definition
    • exposure to chemical irritant
  • Pathogenesis
    • acid
      • hydrochloric acid in pool cleaners
      • sulfuric acid in car batteries
      • can denature proteins in the cornea
    • alkali
      • cleaning solutions (i.e., ammonia and lye)
      • fertilizers
      • direct surface damage
      • can also penetrate cell membrane (lipophilic) causing injury to deeper structures in the globe of the eye
  • Treatment
    • initial management
      • immediate irrigation with tap water or saline 
      • do not use acid or alkali solutions
      • do not delay irrigation to contact a medical provider or to go to the ED
    • further management depends on severity of injury as assessed by an ophthalmologist
      • often includes a topical antibiotic to prevent superinfection
      • may also include a topical steroid to decrease inflammation
      • for severe injury, debridement of necrosis may be indicated
Intraocular Foreign Body
  • Definition
    • a foreign body found within the eye
  • Pathogenesis
    • a foreign body traverses the eye (e.g., metal rods and shattered glass)
      • most cases are a metallic foreign body and are found in the vitreous cavity
  • Presentation
    • symptoms
      • patients may describe feeling an object entering the eye
        • it may not alter vision
    • physical exam
      • may find an entering wound
  • Studies
    • a slit-lamp examination with fluorescein stain is performed 
    • computerized tomography (CT) scan of the eye 
      • indication
        • to located the intraocular foreign body
        • this is the imaging study of choice
    • the intraocular foreign body or vitreous humor may be cultured when infection is suspected
  • Treatment
    • antibiotic therapy
      • indication
        • to address the risk of infection and may be started before surgery is initiated
    • tetanus prophylaxis
      • indication
        • used depending on the patient's tetanus immunization status
    • ophthalmic surgery
      • indication
        • definitive treatment to remove the foreign body
Corneal Ulcer
  • Definition
    • an ulcer of the cornea commonly caused by bacteria
  • Pathogenesis
    • a bacterial infection from trauma or extended contact lens use
  • Presentation
    • symptoms
      • profound eye pain and impaired vision
    • physical exam
      • a red eye without unique findings
      • impaired vision
  • Studies
    • slit lamp exam with fluoresein stain
      • uptake in the corneal ulcer with an oval, ragged border lesion
  • Treatment 
    • topical antibiotics
      • ciprofloxacin for contact lens wearers (covers for Pseudomona aeruginosa)
    • surgical debridement
      • emergently performed

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