Ocular Trauma - Assessment and Management

Introduction

Ocular trauma refers to any injury to the eye. It is one of the least-recognized causes of vision loss. It can result from accidents, sports injuries, or assaults and may lead to various complications depending on the extent and location of the injury. Immediate medical attention is important to assess and treat the trauma effectively and prevent long-term vision problems. The injured eye is examined by the ophthalmologist to manage the signs and symptoms.

What Is Ocular Trauma?

Ocular trauma is a broad term used to describe a physical or chemical injury to the eyes that can be a minor scratch to severe damage caused by blunt force or penetrating objects. Ocular trauma results in pathology of the ocular surface and adnexa (tissues surrounding the eye).

What Are the Common Types of Ocular Trauma?

Common types of ocular trauma include:

• Corneal Abrasions: Scratches on the surface of the cornea, often caused by foreign objects, fingernails, or contact lenses.

• Chemical Burns: Exposure of the eye to harmful chemicals, such as acids or alkalis, that damage the cornea and surrounding tissues.

• Blunt Force Trauma: Impact injuries to the eye, which can result from accidents, sports injuries, or assaults, causing bruising, swelling, or even fractures of the bones surrounding the eye.

• Penetrating Injuries: Occur when a foreign object, like a piece of metal or glass, enters the eye, potentially causing severe damage to intraocular structures.

• Orbital Fractures: Fractures of the bones surrounding the eye (orbit), commonly caused by blunt trauma, resulting in swelling, bruising, and possible displacement of the eyeball.

• Hyphema: Bleeding into the front chamber of the eye (between the cornea and the iris), often caused by blunt trauma, which can lead to vision impairment and increased intraocular pressure.

• Retinal Tears or Detachments: Trauma to the eye can cause tears or detachments of the retina, leading to symptoms such as flashes of light, floaters, or sudden vision loss.

• Conjunctival Lacerations: Cuts or tears in the conjunctiva (the thin, transparent membrane covering the white part of the eye and the inner surface of the eyelids), usually caused by sharp objects or trauma.

How Does Ocular Trauma Manifest?

Signs and symptoms of ocular trauma can vary depending on the type and severity of the injury, including:

• Pain or discomfort in the eye.

• Redness or bloodshot appearance.

• Swelling or bruising around the eye.

• Blurred or decreased vision.

• Sensitivity to light (photophobia).

• Double vision.

• Foreign body sensation or the feeling that something is in the eye.

• Tearing or watering of the eye.

• Bleeding from the eye or eyelid.

• Changes in the shape or appearance of the eye.

• Difficulty moving the eye or eyelid.

• Pupil abnormalities, such as unequal size or irregular shape.

• Loss of consciousness (in cases of severe head trauma).

How Is Ocular Trauma Confirmed?

Ocular trauma is typically diagnosed through a combination of medical history, physical examination, and sometimes imaging tests. Below is the sequence of tests to be done to diagnose ocular trauma.

• Medical History: The doctor will ask about the circumstances surrounding the injury, including how it occurred, any symptoms experienced, and any previous eye conditions or surgeries.

• Physical Examination: The doctor will conduct a thorough examination of the eyes to assess the extent of the injury. This may include checking visual acuity, examining the external and internal structures of the eye and assessing eye movement and alignment.

• Imaging Tests: Imaging tests such as X-rays, CT scans, or MRI scans may be done to assess the extent of the trauma and evaluate any damage to the eye or surrounding structures.

• Additional Tests: Depending on the specific circumstances, additional tests such as intraocular pressure measurement (tonometry), slit-lamp examination, or ultrasound may be performed to further evaluate the injury.

How Is Ocular Trauma Managed?

The management and treatment of ocular trauma depend on the severity and nature of the injury. Here are some general guidelines:

• Immediate First Aid: If there is an object embedded in the eye, do not attempt to remove it. Cover the eye gently with a clean, sterile dressing or cloth and seek immediate medical attention. If chemicals have entered the eye, rinse it with clean water before seeking medical help.

• Medical Evaluation: Seek prompt medical evaluation by an ophthalmologist or healthcare professional experienced in eye injuries. They will assess the extent of the trauma through a thorough examination and may prescribe imaging tests such as X-rays, CT scans, or MRI scans if necessary.

• Medications: Depending on the type of injury, the doctor may prescribe medications such as antibiotic eye drops or ointments to prevent infection, corticosteroid eye drops to reduce inflammation or pain relievers.

• Surgery: In severe cases of ocular trauma, surgical intervention may be necessary to repair damage to the eye or surrounding structures. This could include procedures such as suturing lacerations, removing foreign objects, repairing retinal detachments, or performing reconstructive surgery.

• Follow-up Care: Follow any instructions provided by the healthcare provider regarding medication use, wound care, and activity restrictions. Attend follow-up appointments as scheduled to monitor healing and address any complications.

• Eye Protection: After recovering from ocular trauma, it is important to protect the eyes from further injury. This may involve wearing protective eyewear during sports or hazardous activities and avoiding situations where eye injury is likely.

• Vision Rehabilitation: In cases where ocular trauma results in vision loss or impairment, vision rehabilitation services may be helpful. These services can include vision therapy, adaptive techniques, and assistive devices to maximize remaining vision and improve quality of life.

How About the Prognosis of Ocular Trauma?

One commonly used system is the Ocular Trauma Score (OTS), which helps predict visual outcomes following ocular trauma. The OTS includes the following components:

• Visual Acuity: Initial visual acuity is measured and assigned a score ranging from 1 to 5, with 1 being no light perception and 5 being normal visual acuity.

• Globe Injury: The type and extent of globe injury are assessed and assigned a score ranging from 1 to 5, with 1 being a contusion without rupture and 5 being a rupture or penetrating injury with extensive tissue damage.

• Traumatic Retinal Detachment: The presence or absence of traumatic retinal detachment is determined and assigned a score of 1 or 3, respectively.

• Endophthalmitis: The presence or absence of endophthalmitis (infection within the eye) is determined and assigned a score of 1 or 4, respectively.

The total OTS score is calculated by adding the scores from each component, with a higher score indicating a better prognosis for visual recovery. This scoring system helps clinicians assess the severity of ocular trauma and guides them on appropriate treatment and a better prognosis.

Conclusion

Ocular trauma is preventable if protective gears are used properly. Once the diagnosis is confirmed, appropriate treatment will be prescribed, which may include medications, eye drops, protective eyewear, or, in severe cases, surgery. It is essential to seek prompt medical attention for ocular trauma to prevent potential complications and preserve vision. Delaying treatment can lead to permanent damage and vision loss.