Eye Lunetta et al.

Suicide by intracerebellar
ballpoint pen. Am J Forensic Med Pathol.

Injuries
2002 Dec;23(4):334-7

At publication, one of the only known

suicides on record from a “low-velocity”
penetrating object

Dr. Rana Greene AA, BA, MBBS, MMED, FCOPHTH

Ophthalmologist and Glaucoma Specialist
No disclosures to declare
 Lid Corn
Laceration eal
La c e
ratio
n
Corneal
abrasion

Spectrum of Eye Injuries

Learning
objectives
To understand the:

1.Impact of eye injuries

2.Risks factors for eye injuries
3.Types of eye injuries
4.Approach to patients with eye injuries
Defining eye
injuries
Trauma inflicted to the eye by external
means which may result in
surface or deep injury to:
soft tissue
bony orbit and/or
intraocular injuries
Significance of Eye
Injuries
• Ocular trauma is a major public health issue
Medical care costs Loss of career opportunities
Reduction in vision Major lifestyle changes
Socioeconomic burden Psychological impact
Vocational rehabilitation Permanent physical disfigurement

• 52% cases affect kids**

• Leading cause of preventable monocular blindness3-6
3. May et al. The epidemiology of serious eye injuries from the United States Eye Injury Registry. Graefes Arch Clin Exp
Ophthalmol 2000; 238(2):153–7
4. Phan et al. Trauma: Introduction. American Academy of Ophthalmology. Knights Templar Eye Foundation. 2015.
Available https://www.aao.org/disease-review/introduction-to-trauma
5. Huabin et al. (2018) Trends in Eye Injuries and Associated Medical Costs among Children in the US, 2002–2014,
Prevalence of Eye
Injuries
• 2.4 million eye injuries annually in US7,8
• 90% of all eye injuries are preventable,
especially in kids
• 3rd most common indication for hospital
admission in emergency departments in
kids9,10

7. US Eye Injury Registry. Epidemiology: scope of the problem. Available at Http://www.useironline.org/epidemiology [Last cited on
2014 Feb 08]
8. Négrel et al. The global impact of eye injuries. Ophthalmic Epidemio 1998;5:143–69
9. Pollard et al. Pediatric eye injuries treated in US emergency departments,1990-2009. Clin Pediatr (Phila) 2012;51: 374–81
10. Cao et al. Epidemiology of patients hospitalized for ocular trauma in the Chaoshan region of China, 2001-10. PLoSOne 2012;7
 Trends of eye injuries requiring surgical
management in PMH during June 2013 – Dec.
2018

• Total Surgical Cases = 4,784

• Total Eye Trauma Cases requiring
surgery = 104
• Patient ages: 1 year to 85 years
 Trends of eye injuries requiring surgical
management in PMH during June 2013 – Dec.
2018

Most common injuries:

1. Globe rupture
2. Lid lacerations
Risk Factors for Eye
Injuries
Males
Age 18 – 35years
Hammering
Workplace
Road accidents
Chemical exposure
Sports
Falls
Alcohol use/ Brawls
Fireworks and Firearms
Lower socioeconomic
background
12.
6,7
Mowatt et al. Hospitalization trends in adult ocular trauma at the University Hospital of
the West Indies. West Indian MedJ 2012;61:605–9
Types of Eye
Injuries
• Blunt Trauma

• Penetrating Trauma

• Foreign Bodies
Orbital Anatomy
Intraocular

• Orbital Wall Fractures

• Chemical Injuries
Recognizing Eye Injuries
DO
Do NOT touch
Do NOT rub NOT
Do NOT apply pressure
Do NOT remove foreign
objects
 Histor Examination
y
• Details: time, nature of injury, • Check vision – both
chemicals etc eyes
• Which eye? • Check pupil - size or
• Blurred vision
• Pain, swelling
shape
• Foreign body sensation
• Look for foreign
• Diplopia body, redness etc.
• Red eye • Ocular motility
• Discharge • Proptosis/
• Floaters Enophthalmos
• Tearing
• Previous eye injury/issues/meds?
• Protective eye wear?
• Immunization history- Tetanus
 Management: Emergency
Room
 Keep patient NPO (may need urgent surgery)
 Blood works
 IV access, Analgesics, Antibiotics
 Tetanus IM 0.5ml, Antiemetic

 CT Scan – transport patient in wheelchair with eye shield

 Ophthalmology Referral
 Referral: Oromaxillofacial/ENT/Neurosurgery as needed
 YOUR
GOAL
• Protect eye from further injury
• Control Pain
• Prevent Infection
• Control Nausea/ Vomiting
• Refer to Ophthalmology
Blunt Trauma - Anterior
Segment
• Lid Hematoma
• Subconjunctival
Hemorrhage
• Hyphema Subconjunctival Hyphema Iridodialysis Vossius ring
• Iris sphincter hemorrhage
tear
• Iridodialysis
• Traumatic Iritis
• Lens Subluxation Cataract Lens subluxation Angle recession Ruptured globe
• Globe rupture
 Blunt Trauma – Posterior
Segment
• Commotio
Retinae
• Vitreous
Hemorrhage
• Choroidal
Rupture Commotio retinae Vitreous Choroidal rupture/ Retinal dialysis
hemorrhage hemorrhage
• Retinal Dialysis
• Retinal tears
• Macula Hole
• Optic Neuropathy
• Optic Nerve
Transection Equatorial tears Macular hole Optic neuropathy Nerve Transection
Penetratin
g Trauma

• Globe rupture Flat anterior chamber Uveal prolapse Damage to lens and iris

• Lid Lacerations

Vitreous hemorrhage Tractional retinal detachment Endophthalmitis

Lid lacerations
Before

After
 Sound travels – 1126
Orbital Foreign bodies feet per second
Bullet travels - 2600
Nature
feet per second
A)Metallic – Steel, Iron, Aluminum
B)Nonmetallic/ Inorganic – Glass,
Plastic,
C)Organic – Wood, Vegetable matter.

•Metal and glass well tolerated,

•May be left in situ
•Organic matter poorly tolerated →
Inflammatory reaction

Complications
Lsberge et al. Intraorbital Bullet. JAMA Optic nerve compression, infections
Ophthalmol. 2018;136(3):295–6 and extraocular muscle involvement
Intraocular Foreign bodies
• Nature – often metallic
• Complications:
Endophthalmitis, Retinal
Detachment, Siderosis
• Ultrasound very helpful
• Plain X-Rays for metallic
foreign body and if CT
unavailable
• CT Scan (preferred)
• MRI – Defer on use for
metallic foreign body
Orbital Blow out fractures
Orbital
Bones

• Periocular ecchymosis, chemosis and lid

edema
• Infraorbital nerve anesthesia, Muscle
entrapment
Mechanism of Orbital fractures

Basal skull fracture

• Impact to orbit/ face

• Orbital wall fracture
• Fracture increases effective volume of orbit
• Globe displaced downwards and backwards
• Herniation of soft tissue into maxillary
sinus
• Blood in maxillary sinus on x-ray
Chemical
Injury Be WISE
Protect your
EYES!

Scars, Cataract, Loss of Sight

Extensive surgery
Wear protective eye wear for work/ sports/ recreational
activities/yard work
Point spray nozzles away from you
KIDS
•Secure chemicals
•Lock cabinets and drawers
•Safe use of paper clips, pencils, scissors,
bungee cords, wire coat hangers and rubber bands
•Purchase age-appropriate "ASTM“ toys – American
Society for
Testing and Materials safety standards
• Caution with projectile toys - darts, bows and arrows,
pellet/
BB guns and fireworks
•Safety gates at stairs
Thank you
24mm 24mm in orbit

7. Allen et al. Understanding the techniques of eye

removal. Optometry Times. 2017.
Prevalence of Eye
Injuries

• 2.4 million eye injuries annually in US8,9

• 90% of all eye injuries are preventable, especially in kids
• Eye trauma is the 3rd most common indication for hospital
admission in emergency departments in kids10,11

8. US Eye Injury Registry. Epidemiology: scope of the problem. Available at

Http://www.useironline.org/epidemiology [Last cited on 2014 Feb 08]
9. Négrel et al. The global impact of eye injuries. Ophthalmic Epidemio 1998;5:143–69
10. Pollard et al. Pediatric eye injuries treated in US emergency departments,1990-2009. Clin
Pediatr (Phila) 2012;51: 374–81