Summary
Definition
History and exam
Key diagnostic factors
- hyphema
- ecchymosis
- severe eye pain
- blurred vision
- corneal abrasions
- corneal edema
- subconjunctival hemorrhages
- conjunctival lacerations
- punctate epithelial erosions
- loss of sight
Other diagnostic factors
- excessive lacrimation
- conjunctival chemosis
- conjunctival hyperemia
- corneal epithelial defect/abrasion
- open globe injury
- eyelid burns
- photophobia
- diplopia
- miosis
- corneal stromal clouding
- iridodialysis
- conjunctival foreign body
- corneal foreign body
- Descemet membrane tears
- corneoscleral lacerations
- persistent headache
- loss of consciousness
- blood or clear fluid from ears or nose
- inability to move eye(s)
Risk factors
- age 18-45 years
- male sex
- no protective eyewear
- workplace injuries
- fireworks
- exposure to ultraviolet light
- previous eye surgery
Diagnostic investigations
1st investigations to order
- CT scan of head and orbit
Investigations to consider
- plain x-ray
- B-scan ultrasonography
- ultrasound biomicroscopy
- MRI scan of head
- optical coherence tomography
- fluorescein angiography
- fundus autofluorescence
- urine drug screen
- sickle cell trait screen
Treatment algorithm
superficial injuries without a foreign body
hyphema
corneal abrasion
open globe injury
recurrent corneal erosions
Contributors
Authors
Fasika Woreta, MD, MPH
Assistant Professor of Ophthalmology
Residency Program Director
Director, Eye Trauma Center
Wilmer Eye Institute
Johns Hopkins University School of Medicine
Baltimore
MD
Disclosures
FW declares that she has no competing interests.
Acknowledgements
Dr Fasika Woreta wishes to gratefully acknowledge Dr Ron Adelman and Dr Elena Raluca Raducu, previous contributors to this topic.
Disclosures
RA is an author of a reference cited in this topic. ERR declares that she has no competing interests.
Peer reviewers
Patricia Pahk, MD
Assistant Professor of Ophthalmology
Mount Sinai Medical School
New York
NY
Disclosures
PP is an author of a reference cited in this topic.
Scott Fraser, MD, FRCS (Ed), FRCOphth
Consultant Ophthalmologist
Sunderland Eye Infirmary
Sunderland
UK
Disclosures
SF declares that he has no competing interests.
David Allen, MD
Consultant Ophthalmologist
Sunderland Eye Infirmary
Newcastle
UK
Disclosures
DA declares that he has no competing interests.
Guidelines
- Surgical care at the district hospital: ocular trauma
More Guidelines
Log in or subscribe to access all of BMJ Best Practice
Use of this content is subject to our disclaimer