Eye Trauma (Ocular Trauma)

First aid for eye trauma

Avoid aspirin and ibuprofen after a significant blow to the eye unless a doctor says otherwise, because they can increase bleeding inside the eye. Acetaminophen (paracetamol) at the label dose is safer for pain.

For a full first-aid walk-through by injury type, see eye injuries.

Types of eye trauma

Eye doctors classify mechanical injuries using the Birmingham Eye Trauma Terminology (BETT):

Closed-globe injuries

The outer wall of the eye (cornea and sclera) is intact.

• Contusion: a blunt blow bruises structures inside the eye. It can cause bleeding in the front chamber (hyphema), inflammation of the iris (traumatic iritis), a torn iris or lens displacement, and bruising of the retina.
• Lamellar laceration: a partial-thickness cut of the cornea or sclera.
• Superficial injuries: a corneal abrasion or a foreign body sitting on the surface.

Open-globe injuries

The eye wall has a full-thickness wound. These are emergencies.

• Rupture: blunt force bursts the eye from the inside, usually at its weakest points. Often caused by a fist, ball or fall.
• Laceration: a sharp object cuts through the wall. It may be a penetrating injury (one entry wound), a perforating injury (entry and exit), or an injury with an intraocular foreign body retained inside. See penetrating eye injury.

Other categories

• Orbital injuries: a blow can break the thin floor or wall of the socket (orbital fracture), trapping eye muscles and causing double vision.
• Eyelid injuries: cuts near the inner corner can sever the tear duct and need specialist repair.
• Chemical injuries: alkalis (lye, lime, oven and drain cleaners, cement) penetrate deeper and do more damage than acids.
• Thermal, radiation and UV injuries: burns, welding flash and snow blindness.

Symptoms

• eye pain, light sensitivity and watering
• blurred or reduced vision
• redness or blood on the white of the eye or in front of the iris
• a pupil that is irregular, teardrop-shaped or a different size
• double vision or limited eye movement
• swelling and bruising of the lids
• the eye looking sunken or bulging

Pain can be surprisingly mild with serious injuries, especially small high-speed fragments.

How eye trauma is assessed

1. History: what hit the eye, how fast, whether metal, chemical or organic material was involved, and tetanus status.
2. Visual acuity: the single most important measure for predicting outcome.
3. Pupil check: an abnormal response can signal optic nerve damage.
4. Slit-lamp exam: a microscope examination, often with fluorescein dye to show scratches and leaks.
5. Eye pressure: measured only once an open globe has been ruled out.
6. Dilated exam of the lens, vitreous and retina.
7. CT scan of the orbits: shows fractures and metal fragments. MRI is avoided when metal is possible.
8. Ultrasound when blood blocks the view of the retina, used gently if the eye is intact.

Treatment

• Superficial injuries: antibiotic drops or ointment and pain control. Most corneal abrasions heal in 1 to 3 days.
• Hyphema: rest with the head raised, a protective shield, steroid and dilating drops, and daily pressure checks for several days.
• Open globe: a rigid shield, IV antibiotics, tetanus protection, anti-nausea medicine, and surgical repair, ideally within 24 hours. Further surgery for cataract or retina is common.
• Orbital fractures: often observed, with surgery if muscles are trapped or the eye sinks.
• Chemical injuries: prolonged irrigation until the eye's pH is normal, then steroids, antibiotics and sometimes surgery to the surface.

Long-term complications

Some problems appear weeks to years after the injury, so follow-up matters:

• Traumatic glaucoma: damage to the drainage angle can raise eye pressure years later. Yearly pressure checks are advised after a significant blunt injury.
• Traumatic cataract: clouding of the lens.
• Retinal detachment: watch for new floaters, flashes or a shadow.
• Endophthalmitis: infection inside the eye, a risk after open-globe injury.
• Sympathetic ophthalmia: a rare immune attack on the uninjured eye after a penetrating injury.
• Corneal scarring and permanent vision loss.

Prevention

Around 90% of serious eye injuries could be prevented with proper eye protection. Wear ANSI Z87.1-rated safety glasses for power tools, yard work and DIY; polycarbonate sports goggles for racquet sports, basketball and paintball; and keep household chemicals and fireworks away from children. People with sight in only one eye should wear protective lenses at all times.

Frequently asked questions

What is the difference between open and closed globe injury?

In a closed-globe injury, the outer wall of the eye is intact, although structures inside can be bruised or bleeding. In an open-globe injury, there is a full-thickness cut or rupture through the cornea or sclera. Open-globe injuries need emergency surgery to close the eye and prevent infection.

What are the signs of a serious eye injury?

Reduced vision, blood in front of the iris, an irregular pupil, an object stuck in the eye, fluid leaking from the eye, double vision, or pain that worsens rather than eases. Any chemical exposure is also serious. These need emergency care, not a wait-and-see approach.

Can blunt eye trauma cause problems later?

Yes. A hard blow can damage the eye's drainage system and cause glaucoma years later, and it can cause cataracts or retinal tears and detachment. Have regular eye pressure checks after a significant injury and get urgent care for new floaters, flashes or vision loss.

How long does eye trauma take to heal?

Minor scratches heal in 1 to 3 days. A black eye fades in 1 to 2 weeks. Hyphema usually clears within 1 to 2 weeks. Open-globe injuries and retinal damage can take months of recovery and several operations, and vision may not fully return.

Should I go to the ER for an eye injury?

Go to the ER, or call 911 or your local emergency number, for chemical splashes, cuts or objects in the eye, vision loss, blood inside the eye, or double vision after a blow. For milder irritation, an urgent same-day visit to an eye doctor or urgent care is usually appropriate.