Eye Trauma & Foreign Body Removal

What is Eye Trauma?

Eye trauma essentially refers to any eye injury caused to the eye by blunt trauma. It may be a medical emergency depending on the severity of the trauma.

Types of Eye Trauma

The type of eye trauma can be determined by the type of injury and the event causing the trauma. Speaking broadly, eye trauma can be differentiated into 

• Eye Tissue Injury - blunt injuries, chemical burns, radiation burns,
• Foreign Body - penetrating injuries, and
• Eye Structure Trauma - open globe injuries to the orbit and surrounding tissue.

Who Does Eye Trauma Affect?

Eye trauma can be experienced by anyone and at any age since it’s an external event. It may be more common in certain occupations than others such as boxing or wrestling or high-risk contact sports. It can also be caused by physical violence such as in the case of a fight or domestic disturbance. 

The group identified to be at most risk of eye trauma is defined as men between the age of 18 – 45 years, who get injuries due to workplace accidents, fireworks and extreme exposure to sunlight. 

Men are nearly four times at greater risk of experiencing eye trauma than women.

How Does Eye Trauma Occur?

As the eye gets hit with blunt force, the direct impact causes the eye to compress and retract, leading to blood pooling underneath the affected area, and causing symptoms of trauma. 

In chemical injuries, the alkali directly damages the structures of the eye, causing a chemical reaction leading to cell death, often resulting in irreparable damage. 

Penetrating injuries cause trauma by physical perforation of the eye and its structures as well, disrupting normal anatomy. 

Causes Of Eye Trauma?

Causes of eye trauma can be based on the type of injury (blunt, penetrating, chemical, high-velocity object) and source of injury as below:

• Injuries caused at the workplace account for 19% of all eye trauma
• Fireworks account for roughly 47% of all trauma in children and youths under 20 years of age
• It is estimated that nearly half the ocular injuries occur at home, 19% at work, 16% due to street and highway trauma and 13% are caused due to sports and other recreational activities.

Symptoms of Eye Trauma

The symptoms of eye trauma are wide-ranging and can be one or more of the following: 

• Loss of vision
• Pain (severity may vary according to injury)
• Difficulty seeing out of the eye
• Incision injuries to the eyelid
• Eye not moving normally
• Expulsion of the eye from the orbital socket (medical emergency)
• Penetrating injury with a foreign object stuck inside the eye
• Bloodshot eye due to pooling of blood
• A red – painful-looking eye. 

How is Eye Trauma Diagnosed?

Early diagnosis is important because it helps improve the final outcome. This is done by 

• taking history and conducting 
• a full basic ophthalmologic exam including a slit-lamp examination. 

Furthermore, certain ocular tests are performed to determine the extent of an injury and for further evaluations. These include 

• Biomicroscopy, 
• Seidel test, 
• Ophthalmoscopy, Gonioscopy and 
• Tonometry among others (OCT etc.)

CT scan of the head and orbit is also very important to rule out a concussion and identify fractures in case of blunt injury trauma. 

How is Eye Trauma Treated?

The treatment for eye trauma is determined according to the specific injury caused. Certain injuries require immediate medical attention. 

In terms of superficial injuries, icing, analgesics and rest are recommended, along with the use of an eye patch in certain cases. The physician may also prescribe eye drops depending on the case. 

Chemical injuries are to be treated immediately and require prompt flushing of the eye with saline water and consultation with a specialist.

Penetrating injuries need to be assessed and treated as needed, however, in extreme injuries, loss of eye may be inevitable.

Depending on the injury and its type, topical antibiotics and analgesic drops are also prescribed as part of treatment.

What If Eye Trauma Is Untreated

 Eye trauma can be very distressing. It can result in immediate excruciating pain and can debilitate a person for a long duration. 

In severe injuries, if treatment is not sought, loss of eye or loss of vision is a virtual possibility. In 10% of cases, people indeed lose vision in the injured eye.