Eye trauma - Symptoms, Causes, Images, and Treatment Options

Diseases

Highlights & Basics

Key Highlights

Eye trauma is an important cause of monocular visual impairment and blindness that most commonly affects working age males.
Worldwide, an estimated 55 million people experience an eye injury each year, with 1.6 million developing blindness, 2.3 million developing bilateral low vision, and almost 19 million developing unilateral blindness or low vision.
Eye injuries may be due to mechanical trauma (blunt or penetrating), chemical agents, thermal burns, or exposure to ultraviolet or ionizing radiation.
Seeking prompt medical attention after an eye injury is critical to prevent irreversible sequelae.
It is important to make the public aware of the benefits of using protective equipment because most eye injuries are preventable.

Subconjunctival hemorrhage

Used with kind permission from Drs Smith, Severn, and Clarke

Quick Reference

History & Exam
- Key Factors
- Other Factors
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Diagnostics Tests
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Treatment Options
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Definition

Epidemiology

Etiology

Pathophysiology

Images

The ABCs of ocular trauma evaluation
Subtarsal foreign body. Vertical corneal abrasions
Corneal foreign body
Penetrating corneal injury with iris prolapse
Subconjunctival hemorrhage
Corneal abrasion seen with fluorescein stain
Coronal CT reconstruction with bone (a) and soft tissues (b) algorithms of an isolated orbital floor fracture. a Right orbital floor fracture with involvement of the medial aspect of the infraorbital groove (white arrow) and dislocation of a bony fragment into the maxillary sinus (empty arrow). b Mild swelling of the right inferior rectus muscle (arrowhead) partially herniated into the bony defect; huge herniation of the intraorbital fat through the fracture gap; within the herniated soft tissue, hematomas are recognizable (asterisks)
$Axial CT acquisition with bone (a) and soft tissues (b) algorithms in a patient with a current frac$
Axial CT acquisition with bone (a) and soft tissues (b) algorithms in a patient with a current fracture of the right orbital medial wall (white arrow) and a previous fracture of the contralateral orbital medial wall (empty arrow). a Extensive discontinuation of the right lamina papyracea (white arrow). b The medial rectus muscle is swollen, displaced medially, and partially entrapped into the fracture (asterisk); presence of hemosinus, visible as a right posterior ethmoidal cell occupied by hyperdense material (blood) (arrow)
Corneal ulcer seen with fluorescein stain

Citations

Key Articles

Kuhn F, Mester V, Berta A, et al. Epidemiology of severe eye injuries: the United States Eye Injury Registry (USEIR) and the Hungarian Eye Injury Registry (HEIR) [in German]. Ophthalmologe. 1998 May;95(5):332-43.[Abstract]
Kuhn F, Morris R, Witherspoon CD. Birmingham Eye Trauma Terminology (BETT): terminology and classification of mechanical eye injuries. Ophthalmol Clin North Am. 2002 Jun;15(2):139-43.[Abstract]
MacEwen CJ. Ocular injuries. J R Coll Surg Edinb. 1999 Oct;44(5):317-23.[Abstract]
American Academy of Ophthalmology. Policy statement: referral of persons with possible eye diseases or injury. Apr 2014 [internet publication].[Full Text]

Other Online Resources

Prevent Blindness America: eye health and safety

Referenced Articles

1. Kuhn F, Mester V, Berta A, et al. Epidemiology of severe eye injuries: the United States Eye Injury Registry (USEIR) and the Hungarian Eye Injury Registry (HEIR) [in German]. Ophthalmologe. 1998 May;95(5):332-43.[Abstract]
2. Kuhn F, Morris R, Witherspoon CD. Birmingham Eye Trauma Terminology (BETT): terminology and classification of mechanical eye injuries. Ophthalmol Clin North Am. 2002 Jun;15(2):139-43.[Abstract]
3. Kuhn F, Morris R, Witherspoon CD, et al. The Birmingham Eye Trauma Terminology system (BETT). J Fr Ophtalmol. 2004 Feb;27(2):206-10.[Abstract]
4. Négrel AD, Thylefors B. The global impact of eye injuries. Ophthalmic Epidemiol. 1998 Sep;5(3):143-69.[Abstract]
5. Swain T, McGwin G Jr. The prevalence of eye injury in the United States, estimates from a meta-analysis. Ophthalmic Epidemiol. 2020 Jun;27(3):186-93.[Abstract]
6. Maltzman BA, Pruzon H, Mund ML. A survey of ocular trauma. Surv Ophthalmol. 1976 Nov-Dec;21(3):285-90.[Abstract]
7. Desai P, MacEwen CJ, Baines P, et al. Epidemiology and implications of ocular trauma admitted to the hospital in Scotland. J Epidemiol Community Health. 1996 Aug;50(4):436-41.[Abstract][Full Text]
8. Briner AM. Penetrating eye injuries associated with motor vehicles accidents. Med J Aust. 1976 Jun 12;1(24):912-4.[Abstract]
9. Usmani B, Latif A, Iftikhar M, et al. Eye trauma in falls presenting to the emergency department from 2006 through 2015. Br J Ophthalmol. 2021 Feb;105(2):198-204.[Abstract]
10. Katz J, Tielsch JM. Lifetime prevalence of ocular injuries from Baltimore eye survey. Arch Ophthalmol. 1993 Nov;111(11):1564-8.[Abstract]
11. Tomaiuolo M, Woreta FA, Li A, et al. Open-globe injury repairs in the American Academy of Ophthalmology IRIS® registry 2014 through 2018: incidence, risk factors, and visual outcomes. Ophthalmology. 2023 Mar 15;S0161-6420(23)00154-9.[Abstract]
12. Channa R, Zafar SN, Canner JK, et al. Epidemiology of eye-related emergency department visits. JAMA Ophthalmol. 2016 Mar;134(3):312-9.[Abstract][Full Text]
13. Cole MD, Clearkin L, Dabbs T, et al. The seat belt law and after. Br J Ophthalmol. 1987 Jun;71(6):436-40.[Abstract][Full Text]
14. Kuhn F, Morris R, Witherspoon C. Eye injury and the air bag. Curr Opin Ophthalmol. 1995 Jun;6(3):38-44.[Abstract]
15. Lee WB, O'Halloran HS, Pearson PA, et al. Airbags and bilateral eye injury: five case reports and a review of the literature. J Emerg Med. 2001 Feb;20(2):129-34.[Abstract]
16. Consumer Product Safety Commission. National Electronic Injury Surveillance System 1998-2017. Apr 2018 [internet publication].[Full Text]
17. Wisse RP, Bijlsma WR, Stilma JS. Ocular firework trauma: a systematic review on incidence, severity, outcome and prevention. Br J Ophthalmol. 2010 Dec;94(12):1586-91.[Abstract]
18. MacEwen CJ. Ocular injuries. J R Coll Surg Edinb. 1999 Oct;44(5):317-23.[Abstract]
19. Swan KC, Meyer SL, Squires E. Late wound separation after cataract extraction. Ophthalmology. 1978 Oct;85(10):991-1003.[Abstract]
20. Vinger PF. Injury to the postsurgical eye. In: Kuhn F, Pieramici D, eds. Ocular trauma: principles and practice. New York, NY: Thieme; 2002:280-92.
21. Bengtsson E, Ehinger B. Treatment of traumatic hyphaema. Acta Ophthalmol (Copenh). 1975 Dec;53(6):914-23.[Abstract]
22. Kennedy RH, Brubaker RF. Traumatic hyphema in a defined population. Am J Ophthalmol. 1988 Aug 15;106(2):123-30.[Abstract]
23. Iftikhar M, Mir T, Seidel N, et al. Epidemiology and outcomes of hyphema: a single tertiary centre experience of 180 cases. Acta Ophthalmol. 2021 May;99(3):e394-401.[Abstract][Full Text]
24. Falcinelli G, Falsini B, Taloni M, et al. Modified osteoodonto-keratoprosthesis for treatment of corneal blindness: long-term anatomical and functional outcomes in 181 cases. Arch Ophthalmol. 2005 Oct;123(10):1319-29.[Abstract]
25. Wagoner MD. Chemical injuries of the eye: current concepts in pathophysiology and therapy. Surv Ophthalmol. 1997 Jan-Feb;41(4):275-313.[Abstract]
26. Casson RJ, Walker JC, Newland HS. Four year review of open eye injuries at the Royal Adelaide Hospital. Clin Exp Ophthalmol. 2002 Feb;30(1):15-8.[Abstract]
27. Elder MJ, Stack RR. Globe rupture following penetrating keratoplasty: How often, why, and what can we do to prevent it? Cornea. 2004 Nov;23(8):776-80.[Abstract]
28. Martin GC, Le Roux G, Guindolet D, et al. Pediatric eye injuries by hydroalcoholic gel in the context of the coronavirus disease 2019 pandemic. JAMA Ophthalmol. 2021 Mar 1;139(3):348-51.[Abstract][Full Text]
29. Nash EA, Margo CE. Patterns of emergency department visits for disorders of the eye and ocular adnexa. Arch Ophthalmol. 1998 Sep;116(9):1222-6.[Abstract]
30. American Academy of Ophthalmology. Policy statement: referral of persons with possible eye diseases or injury. Apr 2014 [internet publication].[Full Text]
31. The Royal Children's Hospital Melbourne. Penetrating eye injury. Oct 2022 [internet publication].[Full Text]
32. Sulewski M, Leslie L, Liu SH, et al. Topical ophthalmic anesthetics for corneal abrasions. Cochrane Database Syst Rev. 2023 Aug 9;8(8):CD015091.[Abstract][Full Text]
33. Heath Jeffery RC, Dobes J, Chen FK. Eye injuries: understanding ocular trauma. Aust J Gen Pract. 2022 Jul;51(7):476-82.[Abstract][Full Text]
34. Maloney WF, Colvard M, Bourne WM. Specular microscopy of traumatic posterior annular keratopathy. Arch Ophthalmol. 1979 Sep;97(9):1647-50.[Abstract]
35. Fukuyama J, Hayasaka S, Yamada K, et al. Causes of subconjunctival hemorrhage. Ophthalmologica. 1990;200(2):63-7.[Abstract]
36. Cellina M, Cè M, Marziali S, et al. Computed tomography in traumatic orbital emergencies: a pictorial essay-imaging findings, tips, and report flowchart. Insights Imaging. 2022 Jan 12;13(1):4.[Abstract][Full Text]
37. American College of Radiology. ACR appropriateness criteria: orbital imaging and vision loss-child. 2023 [internet publication].[Full Text]
38. American College of Radiology. ACR-ASNR-SPR practice parameter for the performance of computed tomography (ct) of the extracranial head and neck. 2021 [internet publication].[Full Text]
39. Patel SN, Langer PD, Zarbin MA, et al. Diagnostic value of clinical examination and radiographic imaging in identification of intraocular foreign bodies in open globe injury. Eur J Ophthalmol. 2012 Mar-Apr;22(2):259-68.[Abstract]
40. Lakshmanan A, Bala S, Belfer KF. Intraorbital organic foreign body - a diagnostic challenge. Orbit. 2008;27(2):131-3.[Abstract]
41. Kim YH, Kim H, Yoon ES. Unrecognized intraorbital wooden foreign body. Arch Craniofac Surg. 2018 Dec;19(4):300-3.[Abstract][Full Text]
42. Hwang K, Park CY. Intraorbital wooden foreign body in a soldier. J Craniofac Surg. 2023 Jun 15. doi: 10.1097/SCS.0000000000009482.[Abstract]
43. Kubal WS. Imaging of orbital trauma. Radiographics. 2008 Oct;28(6):1729-39.[Abstract]
44. Green BF, Kraft SP, Carter KD, et al. Intraorbital wood. Detection by magnetic resonance imaging. Ophthalmology. 1990 May;97(5):608-11.[Abstract]
45. Lima-Gomez V, Cornejo-Mendoza AM. Value of ocular hypotony as a predictor of open globe injury in patients with ocular trauma [in Spanish]. Cir Cir. 2004 May-Jun;72(3):177-81.[Abstract]
46. American Academy of Ophthalmology. Pediatric eye evaluations preferred practice pattern. Dec 2022 [internet publication].[Full Text]
47. American Academy of Ophthalmology. Comprehensive adult medical eye evaluation preferred practice pattern. Nov 2020 [internet publication].[Full Text]
48. Bizrah M, Yusuf A, Ahmad S. An update on chemical eye burns. Eye (Lond). 2019 Sep;33(9):1362-77.[Abstract][Full Text]
49. Algarni AM, Guyatt GH, Turner A, et al. Antibiotic prophylaxis for corneal abrasion. Cochrane Database Syst Rev. 2022 May 27;5(5):CD014617.[Abstract][Full Text]
50. Woreta FA, Lindsley KB, Gharaibeh A, et al. Medical interventions for traumatic hyphema. Cochrane Database Syst Rev. 2023 Mar 13;3(3):CD005431.[Abstract][Full Text]
51. Hom J, Sarwar S, Kaleem MA, et al. Topical mydriatics as adjunctive therapy for traumatic iridocyclitis. Cochrane Database Syst Rev. 2020 Aug 25;8(8):CD013260.[Abstract][Full Text]
52. Mir T, Iftikhar M, Seidel N, et al. Clinical characteristics and outcomes of hyphema in patients with sickle cell trait: 10-year experience at the Wilmer Eye Institute. Clin Ophthalmol. 2020;14:4165-72.[Abstract][Full Text]
53. Boldt HC, Pulido JS, Blodi CF, et al. Rural endophthalmitis. Ophthalmology. 1989 Dec;96(12):1722-6.[Abstract]
54. Zuckerman BD, Lieberman TW. Corneal rust ring: etiology and histology. Arch Ophthalmol. 1960 Feb;63:254-65.[Abstract]
55. West JR. Are topical nonsteroidal anti-inflammatory drugs useful for analgesia in patients with traumatic corneal abrasions? Ann Emerg Med. 2019 Feb;73(2):157-9.[Abstract][Full Text]
56. American Academy of Ophthalmology. Topical anesthetics: the latest on use for corneal abrasions. Feb 2024 [internet publication].[Full Text]
57. Chuck RS, Jeng BH, Lum F. Consensus guidelines versus evidence-based medicine in the treatment of corneal abrasions. Ophthalmology. 2024 May;131(5):524-5.[Full Text]
58. Yu CW, Kirubarajan A, Yau M, et al. Topical pain control for corneal abrasions: a systematic review and meta-analysis. Acad Emerg Med. 2021 Aug;28(8):890-908.[Abstract][Full Text]
59. Benson WH, Snyder IS, Granus V. Tetanus prophylaxis following ocular injuries. J Emerg Med. 1993 Nov-Dec;11(6):677-83.[Abstract]
60. Kervick GN, Flynn HW Jr, Alfonso E, et al. Antibiotic therapy for Bacillus species infections. Am J Ophthalmol. 1990 Dec 15;110(6):683-7.[Abstract]
61. Vatne HO, Syrdalen P. Vitrectomy in double perforating eye injuries. Acta Ophthalmol (Copenh). 1985 Oct;63(5):552-6.[Abstract]
62. Jonas JB, Budde WM. Early versus late removal of retained intraocular foreign bodies. Retina. 1999;19(3):193-7.[Abstract]
63. Wani VB, Al-Ajmi M, Lukman T, et al. Vitrectomy for posterior segment intraocular foreign bodies: visual results and prognostic factors. Retina. 2003 Oct;23(5):654-60.[Abstract]
64. Vote BJ, Elder MJ. Cyanoacrylate glue for corneal perforations: a description of a surgical technique and a review of the literature. Clin Exp Ophthalmol. 2000 Dec;28(6):437-42.[Abstract]
65. Moschos M, Droutsas D, Boussalis P, et al. Clinical experience with cyanoacrylate tissue adhesive. Doc Ophthalmol. 1996-1997;93(3):237-45.[Abstract]
66. Su CY, Lin CP. Combined use of an amniotic membrane and tissue adhesive in treating corneal perforation: a case report. Ophthalmic Surg Lasers. 2000 Mar-Apr;31(2):151-4.[Abstract]
67. Wilson SE, Marino GK, Medeiros CS, et al. Phototherapeutic keratectomy: science and art. J Refract Surg. 2017 Mar 1;33(3):203-10.[Abstract]
68. Salari F, Beikmarzehei A, Liu G, et al. Superficial keratectomy: a review of literature. Front Med (Lausanne). 2022;9:915284.[Abstract][Full Text]
69. Rubinfeld RS, Laibson PR, Cohen EJ. Anterior stromal puncture for recurrent erosion: further experience and new instrumentation. Ophthalmic Surg. 1990 May;21(5):318-26.[Abstract]
70. Watson SL, Leung V. Interventions for recurrent corneal erosions. Cochrane Database Syst Rev. 2018 Jul 9;7(7):CD001861.[Abstract][Full Text]
71. Palmer DJ, Goldberg MF, Frenkel M, et al. A comparison of two dose regimens of epsilon aminocaproic acid in the prevention and management of secondary traumatic hyphemas. Ophthalmology. 1986 Jan;93(1):102-8.[Abstract]
72. Clare G, Bunce C, Tuft S. Amniotic membrane transplantation for acute ocular burns. Cochrane Database Syst Rev. 2022 Sep 1;9(9):CD009379.[Abstract][Full Text]
73. Ueda S, Nunn BM, Chauhan R, et al. Sustained dasatinib treatment prevents early fibrotic changes following ocular trauma. Graefes Arch Clin Exp Ophthalmol. 2021 May;259(5):1103-11.[Abstract][Full Text]
74. World Health Organization. Surgical care at the district hospital: ocular trauma. 2003 [internet publication].[Full Text]
75. The Royal Children's Hospital Melbourne. Acute eye injury. October 2022 [internet publication].[Full Text]
76. Jackson ML, Virgili G, Shepherd JD, et al. Vision rehabilitation Preferred Practice Pattern®. Ophthalmology. 2023 Mar;130(3):P271-335.[Abstract][Full Text]
77. Sternberg P Jr, de Juan E Jr, Michels RG. Penetrating ocular injuries: types of injuries and visual results. Retina. 1984 Winter-Spring;4(1):5-8.[Abstract]
78. Sternberg P Jr, de Juan E Jr, Michels RG, et al. Multivariate analysis of prognostic factors in penetrating ocular injuries. Am J Ophthalmol. 1984 Oct 15;98(4):467-72.[Abstract]
79. Weene LE. Recurrent corneal erosions after trauma: a statistical study. Ann Ophthalmol. 1985 Sep;17(9):521-2.[Abstract]
80. Reynolds DS, Flynn HW Jr. Endophthalmitis after penetrating ocular trauma. Curr Opin Ophthalmol. 1997 Jun;8(3):32-8.[Abstract]
81. Muqit MM, Mehat M, Bunce C, et al. Early vitrectomy for exogenous endophthalmitis following surgery. Cochrane Database Syst Rev. 2022 Nov 18;11(11):CD013760.[Abstract][Full Text]
82. Liddy L, Stuart J. Sympathetic ophthalmia in Canada. Can J Ophthalmol. 1972 Apr;7(2):157-9.[Abstract]
83. Damico FM, Kiss S, Young LH. Sympathetic ophthalmia. Semin Ophthalmol. 2005 Jul-Sep;20(3):191-7.[Abstract]
84. Ganesh SK, Narayana KM, Biswas J. Peripapillary choroidal atrophy in sympathetic ophthalmia and management with triple-agent immunosuppression. Ocul Immunol Inflamm. 2003 Mar;11(1):61-5.[Abstract]
85. McPherson SD Jr, Dalton HT. Posterior form sympathetic ophthalmia. Trans Am Ophthalmol Soc. 1975;73:251-63.[Abstract][Full Text]
86. Callahan A. Surgery of the eye: injuries. Springfield, IL: Charles C. Thomas; 1950:240.
87. Haik GM, Coles WH. In: Intraocular injuries: their immediate surgical management. Philadelphia, PA: Lea & Febiger; 1972:17-23.
88. Lyon DB, Dortzbach RK. Enucleation and evisceration. In: Shingleton BJ, Hersh PS, Kenyon KR, eds. Eye Trauma St. Louis. Philadelphia, PA: Mosby-Year Book Inc; 1991:354-67.
89. Gürdal C, Erdener U, Irkeç M, et al. Incidence of sympathetic ophthalmia after penetrating eye injury and choice of treatment. Ocul Immunol Inflamm. 2002 Sep;10(3):223-7.[Abstract]
90. Budde WM, Junemann A. Chalcosis oculi [in German]. Klin Monbl Augenheilkd. 1998 Mar;212(3):184-5.[Abstract]
91. Sneed SR. Ocular siderosis. Arch Ophthalmol. 1988 Jul;106(7):997.[Abstract]
92. Gross JG, King LP, de Juan E Jr, et al. Subfoveal neovascular membrane removal in patients with traumatic choroidal rupture. Ophthalmology. 1996 Apr;103(4):579-85.[Abstract]
93. Cardillo JA, Stout JT, LaBree L, et al. Post-traumatic proliferative vitreoretinopathy. The epidemiologic profile, onset, risk factors, and visual outcome. Ophthalmology. 1997 Jul;104(7):1166-73.[Abstract]
94. Girard P, Mimoun G, Karpouzas I, et al. Clinical risks factors for proliferative vitreoretinopathy after retinal detachment surgery. Retina. 1994;14(5):417-24.[Abstract]
95. Cowley M, Conway BP, Campochiaro PA, et al. Clinical risks factors for proliferative vitreoretinopathy. Arch Ophthalmol. 1989 Aug;107(8):1147-51.[Abstract]
96. Skorpik C, Menapace R, Gnad HD, et al. Silicone oil implantation in penetrating injuries complicated by PVR. Results from 1982 to 1986. Retina. 1989;9(1):8-14.[Abstract]
97. Han JC, Kwun YK, Cho SH, et al. Long-term outcomes of argon laser photocoagulation in small size cyclodialysis cleft. BMC Ophthalmol. 2015 Sep 24;15:123.[Abstract][Full Text]
98. Gross JB, Davis GH, Bell NP, et al. Surgical repair of large cyclodialysis clefts. Eur J Ophthalmol. 2017 May 11;27(3):382-5.[Abstract]
99. Selvan H, Gupta V, Gupta S. Cyclodialysis: an updated approach to surgical strategies. Acta Ophthalmol. 2019 Dec;97(8):744-51.[Abstract][Full Text]
100. Conrath J, Forzano O, Ridings B. Photodynamic therapy for subfoveal CNV complicating traumatic choroidal rupture. Eye (Lond). 2004 Sep;18(9):946-7.[Abstract]
101. Viestenez A. Rupture of the choroid after eyeball contusion: an analysis based on Earlgen Contusion Registry (EOCR) [in German]. Klin Monbl Augenheilkd. 2004 Aug;221(8):713-9.[Abstract]
102. Sipperly JO, Quigley HA, Gass DM. Traumatic retinopathy in primates: the explanation of commotio retinae. Arch Ophthalmol. 1978 Dec;96(12):2267-73.[Abstract]
103. Richards RD, West CE, Meisels AA. Chorioretinitis sclopetaria. Trans Am Ophthalmol Soc. 1968;66:214-32.[Abstract][Full Text]
104. Yamada H, Sakai A, Yamada E, et al. Spontaneous closure of traumatic macular hole. Am J Ophthalmol. 2002 Sep;134(3):340-7.[Abstract]
105. Mester V, Kuhn F. Internal limiting membrane removal for traumatic macular holes. Am J Ophthalmol. 2000 Jun;129(6):769-77.[Abstract]
106. Ferreira N, Monteiro S, Meireles A, et al. Outcome of vitrectomy and chorioretinectomy in perforating eye injuries. Ophthalmic Res. 2015;53(4):200-6.[Abstract]
107. Kuhn F, Schrader W. Prophylactic chorioretinectomy for eye injuries with high proliferative-vitreoretinopathy risk. Clin Anat. 2018 Jan;31(1):28-38.[Abstract]