Ocular Trauma

We often take our eyes for granted, particularly when at work and sometimes even during our leisure time. Over the years, we have seen quite a few people with eye injuries because they did not wear appropriate protective eyewear. A squash ball can reach over 100 km/hr. When it hits the eye, it can cause severe damage. Good protective eyewear is very important.

The eyebrows and the nose protect our eyes, but if a projectile is small enough, it can penetrate into the eye (a sliver of metal from a hammer for example), or can cause a compressive injury causing sometimes the eye to burst open (a fist or squash ball for example). When it first happens, it is hard to know what the outcome of the injury will be. The prognosis is highly variable.

The best treatment in all cases is prevention, avoiding risky situations and taking protective measures such as the use of glasses in activities where it is recommended.

If you suffer trauma to the eye, do not panic!

Protect the eye with a shield or even an inverted paper cup (this way you or someone else will not hit or touch the eye by mistake). Get to a hospital as soon as possible or get the help of an EyeMD. If possible, cover the good eye and check the vision in the eye with trauma if you are able to open it. Knowing how the vision is shortly after the trauma occurred helps us to know if vital structures at the back of the eye have been damaged. If the accident involves or is due to a chemical spill, you should wash the eye as soon as possible with clean water. This can be just tap water. After you flushed the eye with a good stream of water for several minutes (5 to 10 minutes) get professional help as soon as possible.

In the emergency department, they will carefully assess your injured eye. Lesions on the skin and eyelids can appear very striking, but do not necessarily mean that your eyeball has been injured. Only after a thorough exam can an ophthalmologist know how serious the injury was. Knowing the visual acuity soon after the injury is helpful to assess the degree of involvement. Exploration at the slit lamp and funduscopy allow us to evaluate the anatomy of all ocular structures. Ocular mobility and pupil response can give us information on the status of the adjacent structures. It may sometimes be necessary to use imaging techniques such as ultrasound, skull X-Ray or a CT scan to assess structures not visible from the outside.

The treatment will depend on the type and severity of the eye trauma

Occasionally, if the wounds are superficial, just a topical (local) treatment or repair of the skin wound with sutures or sticky tape will be sufficient. The wound must be kept clean and stitches removed at 7 days. Even in these simple cases, you will be asked about your tetanus immunization. If it is not recent (10 years or less), it is a good idea to get a booster.

If the trauma is penetrating (the wound affects the entire thickness of the eyeball and reaches inside the eye), it will first require the closure of the wound. Other surgeries to correct bleeding and damage inside the eye may be done at the same time or delayed by a few days.

During this initial surgery, antibiotics are often injected in the eye. They are sometimes associated with oral or intravenous antibiotics. You will require close and frequent monitoring to insure that the healing process is adequate with little scar tissue formation. The prognosis for vision recovery is related both to the severity of the initial injury and to the formation and location of scar tissue as the eye heals.

It would be difficult to give you a clear and precise overview here of all what might happen or be required after severe trauma to an eye. However, be aware that even if the vision is very poor initially, recovery can be significant. There may be multiple surgeries required over a good half year to a year of follow-up. The surgeries required later are due to the healing process and the consequences that healing has on the function of the eye. You should also know that an injured eye should always be subject to a periodic health check. Most EyeMDs would advise at least one exam once a year.