!!!!!!!!!!!!!! !Kr!ieg!er !Eye!Ins!tit!ute!at!Sin!ai!Ho!spi!tal ! !!!!!!!!!!!!!! !!!!!!!!!!!!!! !e!y!!e !!l!i!g!!h!!t!s ! !!!!!!!!!!!!!! Spring 2006 of injury can occur from a shattered windschield in road traffic OCULAR TRAUMA accidents and from high velocity missiles at the workplace. Foreign bodies are most frequently found on the cornea and under the eyelid where they EYE INJURY can be easily removed. We have seen a progressive increase in eye trauma resulting Eye injury occurs frequently in the United States where nearly from automobile accidents in the past seven years. Frontal air two million individuals require treatment in the hospital (60%) bag deployment was associated with a statistically significant, or doctor’s office (40%) every year. Males are four times more two-fold increased risk of eye injury, whereas seat belt use was likely than females to have ocular injuries, and eye injuries occur associated with a two-fold reduced eye injury risk. Seat belt use mostly among persons in their 20s or younger. However, as the is the most effective means of occupant protection against auto - population ages, we are seeing an increasing number of eye mobile accident-related eye injury. injuries in the elderly. Older age, being female, passenger seat position and collision Most injuries occur in the home, are sports-related or work- severity were also associated with eye injury risk. related or are the result of an assault or result from a motor vehicle accident. The most common objects EYE PROTECTION to strike the eye are fists, thrown objects Many cases of ocular injury can be prevented by wearing (e.g., stones, balls), BBs, pellets and sticks. protective eyeglasses. Many sports-related and occupational Older individuals often suffer ocular trauma injuries can be prevented if appropriate, properly fitted, task- after falling down. Assault and motor vehi - specific eye protection is worn. Sports injuries account for cle injuries are usually the most severe and approximately 100,000 eye injuries each year. These are so may cause so much damage that the eye common because millions of Americans play sports, but few must be removed. wear the appropriate eye protection. Eye and head protection TYPES OF INJURY should be worn by persons playing lacrosse, football, squash, racquetball or paint ball war games. Contusions and abrasions are the most common types of injury. The injured eye may present as a black eye due to bleeding CONCLUSION under the skin and into the One can reduce the risk of ocular injury by being aware of soft tissues that surround those activities that increase the risk of injury and by taking the the eye. The eye may be necessary precautions to minimize or eliminate that risk. painful, particularly if the cornea has been scratched or has a foreign body in it. CORNEAL INJURIES Vision may be reduced if The cornea is the clear covering of the eye. It is a very deli - there is bleeding into the cate structure that must remain smooth and clear for perfect eye or from damage to the vision. Because of the external location of the cornea, when the retina. Double vision may Contusion eyelids are open, the cornea is subject to many different types of occur due to a fracture of trauma. The cornea contains more nerve endings than nearly the bones that support the eyeball or due to hemorrhage around any other part of the body. This means that when a healthy the eye. cornea is injured—even a tiny scratch—it hurts! Penetrating eye injury requires immediate referral because of Three main categories of corneal trauma include corneal the risk of devastating ocular infection. Such injuries are most abrasions, corneal lacerations and corneal infections. commonly seen in children at play with sharp objects. This type continued on page 2 page 2 eye lights CORNEAL ABRASIONS of trauma. Corneal injuries should be evaluated promptly and treated by your ophthalmologist. The cornea has three layers. The outside layer of the cornea, the layer closest to the outside environment, is made up of clear GLAUCOMA CAUSED BY TRAUMA TO THE EYE epithelium, or skin. When this epithelium gets scratched, it is Ocular trauma may cause problems that can usually be cor - called a corneal abrasion. Accidental injury of the cornea (e.g., a rected during the post-traumatic period. These include removal small baby reaches up with his or her fingernail; a coat hanger of a foreign body from the cornea or eyelid, repair of any lacer - or the edge of a piece of paper is moved quickly in front of the ations or damage to the eye and tissues around it, treatment for eye) is very common. When this occurs, symptoms include eye intraocular bleeding, and warm compresses to help the black pain, blurry vision, redness, tearing and the “feeling” that some - and contused eye look and feel better. However, damage may thing is in the eye. The pain is often more noticeable when the occur to the delicate channels that regulate the flow of normal eye is open, and subsides, somewhat, when the eye is closed. intraocular fluids. These channels, called trabecular meshwork, To diagnose a corneal abrasion, an ophthalmologist will are important because they let fluid escape from the eye as fast often use a numbing drop, to temporarily relieve the pain and as new fluid is produced, thereby keeping the intraocular pres - allow for an examination under the microscope. A yellow-col - sure at a normal level. Anything that damages or clogs this tra - ored drop is also often used to temporarily stain the cornea and becular meshwork will cause the intraocular pressure to rise allow for the correct diagnosis. It should be noted that the and produce glaucoma. In time, the glaucoma may cause loss of numbing drop used in the office should never be given to a vision and lead to blindness. patient for pain relief because continued use of such a drop will slow down the healing process. Although the discomfort of a INFLAMMATION corneal abrasion is significant, inappropriate use of the diagnos - Trauma to the eye is likely to stimulate inflammation in and tic numbing drops can result in permanent and severe vision around the eye, a natural process that ordinarily helps the eye loss. Because the cornea has so many nerve endings, it heals to heal. But in some cases, the inflammatory white cells may be quickly. so numerous that they clog the channels Common treatments of corneal abrasions include antibiotic (trabecular meshwork) and lead to a eye drops or ointments to protect the eye from infection; patch - buildup of intraocular pressure and glau - ing the eye closed if the original scratch was not caused by coma. something dirty; or use of a “bandage” contact lens, in more HEMORRHAGE severe cases. Blunt trauma to the eye can occur if it Hyphema, blood in the CORNEA LACERATIONS is hit by a hand or fist, when the eye is lower part of the anterior A cornea can become lacerated if a foreign object cuts into struck by a flying object or missile, or chamber the substance of the cornea. If there is a high velocity sharp when the eye is struck during a fall. This object (e.g., a nail, broken glass, a small rock), the object may sudden blow can cause bleeding around the eye (contusion) or in tear through the cornea and enter the eye. A corneal laceration the eye (hyph-ema, hemorrhage). This mass of red blood cells is a medical emergency and usually requires immediate medical can then clog the trabecular meshwork (channels) and block the care and possibly surgery by an ophthalmologist. If corneal flow of the natural fluids in the eye. This can cause a rapid rise trauma is witnessed, and an object is seen “stuck” to the in intraocular pressure and glaucoma. In many cases, the blood cornea, never attempt to remove the object yourself. Doing so will resorb and disappear in days to weeks. If the eye pressure may cause more damage to the eye. Emergency medical care climbs too high or the blood fails to resorb, then it may be nec - should be sought and only an eye care professional should essary to remove the blood clot in the eye. remove the object. DAMAGE TO THE OUTFLOW CHANNELS (TRABECULAR MESHWORK ) CORNEAL INFECTIONS Even when there is no hemorrhage, trauma to the eye can If a cornea is injured by something “dirty,” it is not uncom - cause permanent damage to the trabecular meshwork. This can mon for the cornea to become infected. Common causes of produce a gradual rise in the intraocular pressure that may take corneal infection after trauma include eye injuries by plants, weeks, months or years to develop. For that reason, it is impor - leaves, sticks or thorns; scratches by the paws of pets; scratches tant to be regularly checked, at least yearly, following trauma to that occur while sleeping in or swimming in contact lenses; or the eye. clean scratches that took a long time to heal, and became TREATMENT infected later. Corneal infections are very serious and can cause permanent visual loss if not appropriately diagnosed or treated. Inflammation in and around the eye can be effectively treated It is common for the cornea to become injured in the setting with warm compresses and eye drops that decrease the intraocu - continued on page 3 eye lights page 3 lar inflammation. Elevated intraocular pressure and glaucoma can sends the information back to the brain, where higher order be effectively treated with conventional glaucoma eye drops. In visual processing occurs, leading to our subjective perceptions of some cases, the intraocular pressure may be so high that it cannot the world around us.