Wounds and injuries

 

Wounds and Injuries

 

Definition

Eyes trauma are very common, of different types, and varying severity.

A careful eye examination is essential, the absence of pain is not a criterion of mildness. 

 

Organ

Different parts of the eye can be affected depending on the trauma.

Eye contusion

Definition

An eye contusion is a bruise around the eye, more commonly known as a black eye. It may result when a blow happens in or near the eye socket. If a bruise appears, it will usually do so within 24 hours of the injury.

Causes

After being struck in the eye or nose, blood leaks into the area surrounding the eye.

Risk Factors

  • Factors that may increase your risk of an eye contusion include:
  • Participation in high-impact sports such as basketball, football, hockey, and boxing
  • Occupations that expose the eye to potential injury, such as manufacturing, construction, and athletics
  • Fighting or other trauma

Symptoms

  • A black and blue or purple mark will appear following the injury. There may also be redness, swelling, and tenderness or pain. After it begins to heal, the contusion may turn yellow.
  • Diagnosis
  • Eye contusions are diagnosed visually. Healthcare providers assume that the eye has been struck in some way. Most people are able to self-diagnose a contusion, but a doctor may confirm the diagnosis.

Treatment

First-aid Treatment

It is important to apply first-aid treatment right away.

Seek emergency medical attention right away if there is any concern that the eye has been injured.

Immediately apply an ice pack for 15-20 minutes at a time to reduce swelling and minimize pain. Do not press on the eye itself. Repeat every 1 to 2 hours for the first 48 hours.

If there is still tenderness after 48 hours, apply a warm compress every 1-2 hours.

Take acetaminophen for pain. Do not take aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen because they can cause or increase bleeding.

Medical Treatment

Many eye injuries are minor and will heal within 2 weeks with basic first aid. There is always the risk of more serious consequences, so you should consider seeing an eye doctor right away, even if you have no symptoms. This should be done urgently if a blow to the eye causes blood to appear in your eye, loss or change in vision, double vision, inability to move the eye normally, or severe pain in your eyeball. Depending on the extent of your injury, your doctor may provide further medical treatment. For instance:

If the skin around your eye is cut, you may need stitches.

If there was any damage to the eye itself, you may need antibiotic eye drops to prevent infection.

Your doctor may prescribe eye drops to minimize swelling.

If there is suspicion of damage to the bones, x-rays or other imaging may be performed

Prevention

To help reduce your chance of an eye contusion:

Wear protective eye covering such as safety goggles whenever the eye is exposed to potential injury at work or play. The best eye coverings fit snug against the skin so that no foreign objects can get underneath them and into the eye.

Avoid situations that may involve fighting.

Source : Mountsinai

 

Perforating eye injuries

Definition

Ocular penetrating and perforating injuries can result in severe vision loss or loss of the eye. Penetrating injuries by definition penetrate into the eye but not through and through--there is no exit wound. Perforating injuries have both entrance and exit wounds. Most individuals sustaining eye injuries are male with an estimated relative risk of 5.5 times greater than women. 

Causes

Penetrating or perforating ocular injuries can be due to injury from any sharp or high velocity object. The home is the most frequent location for injuries. The most common blunt objects reported by May et al from the United States Eye injury Registry were rocks, fists, baseballs, lumber and fishing weights. The most common sharp objects were sticks, knives, scissors, screwdrivers and nails.

Risk factors

As noted from the epidemiological studies above, male gender is a large risk factor for ocular trauma. Failure to wear adequate eye protection while performing high risk activities such as baseball, basketball and use of power tools in the home environment have also been noted to be risk factors for eye injuries. Substance abuse including alcohol and marijuana is also known to increase the risk of eye trauma. 

Prevention

Appropriate and adequate eye protection when performing visually threatening activities is the most effective method to prevent ocular trauma. The American Academy of Ophthalmology Eye injury Snapshot is a yearly survey designed to collect data and educate the public about the causes and prevention of eye injuries. Through educational programs such as this, potential eye injuries may be prevented.

Diagnosis

Ophthalmic examination after severe trauma can be difficult. Obtaining a visual acuity and pupillary examination may be the most important elements to ascertain. (4) Obvious trauma requires careful handling of the eye with care taken to prevent any pressure on the globe if an open globe is suspected.

Once an extraocular muscles and external examination is complete, a thorough conjunctival and anterior segment examination must be completed if penetrating or perforating injury is suspected.

Symptoms

Subconjunctival hemorrhage, shallow or flat anterior chamber, hyphema, iris deformities, lens disruption, or posterior segment findings such as vitreous hemorrhage, retinal tears, retinal hemorrhage are concerning when seen in a patient with suspected trauma.

Patients with penetrating or perforating injuries usually complain of pain or double vision. In more subtle injuries, there may be minor symptoms such as foreign body sensation or blurred vision.

Treatment 

Penetrating or perforating injuries should be evaluated and treated immediately. Depending on the material causing the injury and location of entry, severe vision loss can occur.

If surgical exploration is planned, a fox shield, antiemetics, intravenous antibiotics, and update of tetanus status should be completed.

Globe exploration should be performed in suspected penetrating trauma with possible vitrectomy if vitreous hemorrhage, intraocular foreign body or retinal detachment is present. 

Source : Eye Wiki

 

Burn to the eye and sun

Chemical burns can happen if a solid or liquid chemical or chemical fumes get into the eye. Many substances will not cause damage if they are flushed out of the eye quickly. Acids (such as bleach or battery acid) and alkali substances (such as oven cleansers or fertilizers) can damage the eye. It may take 24 hours after the burn occurs to determine the seriousness of an eye burn. Chemical fumes and vapors can also irritate the eyes.

Burns to the eyelid or eye can cause eye problems. Blasts of hot air or steam can burn the face and eyes. Bursts of flames or flash fires from stoves or explosives can also burn the face and eyes. If you have burns to your eyelids, see the topic Burns.

Eyes that are not protected by a mask or ultraviolet (UV) filtering sunglasses can be burned by exposure to the high-intensity light of a welder's equipment (torch or arc) or to bright sunlight (especially when the sun is reflecting off snow or water). The eyes also may be injured by other bright lights, such as from tanning booths or sunlamps. Exposure to high-intensity light may cause temporary blindness. It may take up to 24 hours for the extent of the eye injury to be known.

After a burn injury to the eye, it is important to watch for signs of an eye infection.

Prevention

The following tips may help prevent burns to the eye:

Wear safety glasses, goggles, or face shields when working with power tools or chemicals or when doing any activity that might cause an object or substance to get into your eyes. If you work with hazardous chemicals that could splash into your eyes, be aware of the proper procedure for flushing out chemicals, and know the location of the nearest shower or sink.

Wear a mask or goggles designed for welding if you are welding or near someone else who is welding.

Injuries from ultraviolet (UV) light can be prevented by wearing sunglasses that block ultraviolet (UV) rays and by wearing broad-brimmed hats. Be aware that the eye can be injured from glare during boating, sunbathing, and skiing. Use eye protection while under tanning lamps or when using tanning booths.

Source : WebMD

Treatment 

With chemical injury, immediate initiation of copious irrigation has the greatest impact on prognosis. Irrigation also helps to clear any residual particulate matter from the eye. Delayed treatment may result in significant morbidity.

Ideally, the affected eye should be irrigated as soon as possible in an eyewash or shower station with sterile saline solution. Sterile physiologically balanced solutions reduce the chances of further damage to the eye. If sterile saline is not available, cold tap water allows dilution of the agent.

 

The patient must try to open the eyelids as wide as possible to obtain the best irrigation. Topical anesthetic prior to irrigation or insertion of a lid speculum, such as the Morgan lens, facilitates cooperation. A wire lid speculum can also be used to assist in eyelid retraction.

For more severe burns, particularly alkali burns, hospitalization is necessary. The patient will require topical ophthalmic antibiotics, pain medication, cycloplegics, and mydriatics. If secondary glaucoma develops, the patient will require ocular pressure–lowering medication. Inpatient treatment in a burn center is required for patients with more severe burns or alkali burns.

Active surgical intervention to remove necrotic tissue can optimize the outcome by reducing continued inflammation. In selected cases, amniotic membrane patching may also be considered. Tissue engineering for conjunctival reconstruction is a developing field that may offer new therapies as well. In one study, subconjunctival application of autologous regenerative factor-rich plasma (RFRP) was effective in treating ocular alkali burns.

Source : Emedecine

Images

A small piece of iron has lodged the margin of the cornea

Foreign body in eye

SourceBy E van Herk (E van Herk) [GFDL or CC-BY-SA-3.0], via Wikimedia Commons

 

Eye injury by impact of small plastic body

Eye injury

Source : "Petr Novák, Wikipedia", via Wikimedia Commons

 

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