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Eye trauma

Last reviewed: 10 Nov 2024
Last updated: 30 Oct 2024
30 Oct 2024

Limit topical anesthetics to single use for initial symptom relief and to aid exam

Repeated use of topical anesthetics may be toxic to the corneal epithelium and may impair healing (e.g., risks corneal melting, ring infiltrates, and infection).[32][56][57]​​​

Topical anesthetics can provide initial symptom relief and aid exam in patients with corneal abrasions or recurrent corneal erosions, but should be limited to single use by a medical professional.[32][56][57]​​​

Patients should not receive topical anesthetics for use at home.[57]

See Management: approach

Original source of update

Summary

Definition

History and exam

Key diagnostic factors

  • hyphema
  • ecchymosis
  • severe eye pain
  • blurred vision
  • corneal abrasions
  • corneal edema
  • subconjunctival hemorrhages
  • corneal and conjunctival lacerations
  • punctate epithelial erosions
  • loss of sight
Full details

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)
Full details

Risk factors

  • age 18-45 years
  • male sex
  • no protective eyewear
  • workplace injuries
  • falls
  • fireworks
  • exposure to ultraviolet light
  • previous eye surgery
  • alcohol-based hand sanitizers
Full details

Diagnostic tests

1st tests to order

  • CT scan of orbit
  • CT scan of head
  • MRI scan of head
Full details

Tests to consider

  • plain x-ray
  • B-scan ultrasonography
  • ultrasound biomicroscopy
  • optical coherence tomography
  • fluorescein angiography
  • fundus autofluorescence
  • urine drug screen
  • sickle cell trait screen
Full details

Treatment algorithm

ACUTE

superficial injuries without a foreign body

hyphema

corneal abrasion

open globe injury

ONGOING

recurrent corneal erosions or poor healing

Contributors

Authors

Fasika Woreta, MD, MPH

Associate 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

ERR declares that she has no competing interests.

Peer reviewers

Yewlin E. Chee, MD

Assistant Professor of Ophthalmology

University of Washington

Seattle

WA

Disclosures

YE declares that she has no competing interests.

Andrew W. Eller, MD

Professor of Ophthalmology

University of Pittsburgh School of Medicine

Pittsburgh

PA

Disclosures

AE declares that he has no competing interests.

Saloni Kapoor, MD

Clinical Assistant Professor of Medicine

UPMC Mercy Hospital

Pittsburgh

PA

Disclosures

SK declares that she has no competing interests.

Seanna Grob, MD, MAS

Assistant Professor of Ophthalmology

Oculoplastic Surgeon

University of California San Francisco

San Francisco

CA

Disclosures

SG has written a book on ocular trauma.

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