Eyes trauma

Eyes traumas do affect the eyes, but they can also involve eyelids and eye socket lesions. Eye traumas can be simple bruises such as blood effusions but also piercing wounds due to foreign bodies within the eyes. Finally, they can be burns, for instance caused by chemical products.
Some pieces of information should be registered when faced with the traumas in order to cope with possible complications.

What are the different possible eyes traumas?
The different possible eyes traumas are:
• Bruises, simple or with eyeball rupture.
• Piercing wounds with or without foreign bodies within the eyes
• Eyelids and eye socket traumas
• Thermal, chemical burns or irradiations.

What are possible simple bruises?
They may harm the foremost or the rear part of the eyeball, and even its totality.
• Isolated sub conjunctiva hemorrhage
This is a blood effusion below the conjunctiva. It is often the consequence of a severe shock without any resulting lesions. It returns to normal within two weeks without treatment.
• Anterior traumatic syndrome
o Hyphema : blood effusion between the cornea and the iris visible to the naked eye.
This is the result of a burst blood vessel in the iris; it spontaneously returns to normal with rest, but may relapse in the following days. Surgery may be necessary in order to drain it out when relapse is too slow and causes eye pressure increase.
o Damage to the lens of the eye : either lens of the eye or cataract dislocation.
o Iris damage.
o Immediate eyes pressure increase resulting from eyes lesions or sometimes without apparent cause.

• Posterior traumatic syndrome
o Vitreous complications: it may be an intra-vitreous hemorrhage or a vitreous hernia
o Retinal complications
 Retina central edema, that is to say a sharp decline in vision due to a vascular spasm, returning to normal within a few days, and without sequel when the edema disappears.
 It can sometimes be hemorrhages located within the retina or spreading into the vitreous.
 Finally, it sometimes is a late retinal detachment often related to retinal periphery lesions.
What are bruises with eyeball rupture?
They occur on fragile eyes and when in the presence of severe myopia
A thorough check-up, with a general anesthesia, must be carried out and the presence of a possible foreign body must be sought after within the eye.
What are piercing wounds?
• Cornea point-shaped wound caused by sticks (metallic needle or plant spike)
• Complex cornea, cornea-scleral and scleral wounds.
Such wounds are often accompanied by cataracts, vitreous bursts and retinal detachments

• Foreign bodies within the eyes
o Metallic foreign bodies. They can be superficial, like emery sand to which welders are exposed, or deep like lead shots which may cause iris, crystalline and retina wounds.
o plant or animal foreign bodies : processionary caterpillars hair, sea urchin spines which cause massive inflammatory reactions and are important surgical issues.
Such wounds require X-ray examinations looking for intra-ocular foreign bodies. They may cause infection and tetanus vaccine must thus be checked.

What are eyelids traumas?
Most of the time, they are caused by:
In children: dog’s bite,
In adults: public road accidents (bikes, motorbikes),
It is then mandatory to check eyeballs and lacrimal tract integrity.
It is imperative that eyes and their visual function be protected.
These traumas may affect only the skin, or the skin and the eyelids cartilage, or the totality of the eyelid thickness.
Surgery will help suture the eyelid step by step but sometimes a global reconstruction will be carried out.

What are eye socket traumas?
 Depending on bone damage, these are:
• Fractured jaw bones and fractured maxillofacial bones
o Brutal temple trauma possibly causing a single fracture of the wall of the eye socket with a diplopia via muscular incarceration.
• Fractures of the internal membranes of the orbit
o Brutal trauma caused by a middle facial shock frequently associated with a fractured forefront and nose. Possible complications include lachrymal, palpebral ocular and cranium complications.
• Frontal-orbital and optical channel fracture with immediate vision loss
o Such fractures combine ophthalmology, ENT and neurosurgery.

The magnitude of the edema and of the eyelids hematoma is a good indication for these traumas.
They can be associated with ENT and neurological spheres.
Such diagnosis need clinical examinations complemented by facial, orbital and brain medical imaging

What are burns?
Burns may be thermal, chemical or caused by irradiations.
• Thermic burns:
o When due to flames, they mainly involve eyelids. Superficial lesions heal without sequel whilst deep lesions may require transplants.
o When due to contact, they are the result of boiling liquids in contact with the eyelid as well as with the eyeball.
• Chemical burns:
These burns can be caused by acid, the effects of which are immediately maximal; or by base, the effects of which still evolve after the accident.
Both burns must be treated as an emergency on the spot and the eyes must be gently and thoroughly cleansed before evacuation towards specialized centers.
• Burns caused by irradiations:
They are caused by UV or infrared exposure.
UVs are responsible for cornea burns such as « snow blindness » or « sun retinitis » macula lesions. Refer to the “Sun leaflet”
Infrareds cause typical glass-blowers cataract.

What type of clinical examination will help identify such traumas?
The examination will always be a comparative one.
The ophthalmologist will carry out a check-up of the visual functions and will measure ocular pressure.
He will carry out a step by step examination starting from the eyelids up to the retina and this will be, when necessary, done with a general anesthesia depending on the magnitude of the conjunctiva palpebral edema.
Depending on the cause of the trauma, he may require an X-ray examination.
Finally, in case of poly trauma, he will carry out an examination of the associated lesions.

What information should be noted when such traumas occur?
The occurrence of traumas causes medical and medical-legal complications.
This is the reason why the circumstances in which the trauma occurred must be set at the same time as the clinical examination.
• Date, place, circumstances, third party involvement must be specified.
• Origin:
o at school or at work
o at home or on the road
o during leisure time:
Children: darts, rifles, throwing stones, snowballs….
Adult: tennis balls, golf, lead shots, cork of a champagne bottle…
o Fights, attacks.

• Extra-ocular associated lesions
• Functional capabilities before the trauma

Date: 10/25/2012
Author: Sylvie ERVE
Organization: centich
Reference: http://www.snof.org/encyclopedie/traumatismes-de-loeil
Only for Members: No
Content type: Good practises
Tags: eyes, trauma, vision
Categories: Medical & Functions, Eye - Vision impairment