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Eye InjuryAka: Eye Trauma, Eye Evaluation in Trauma

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  1. See Also
    1. Sports Related Eye Injury
    2. Eye Tray
  2. Types: Common Eye Injuries
    1. Corneal Abrasion or Corneal Laceration
    2. Globe Rupture
    3. Blunt Eye Trauma
    4. Eye Foreign Body
    5. Eye Chemical Burn
  3. Exam
    1. Visual Acuity (always)
      1. Consider Topical Eye Anesthetic first if light sensitive
      2. Delay only in cases of Chemical Eye Injury (irrigation precedes acuity exam)
    2. Visual fields by confrontation
      1. Defect suggests retinal, Optic Nerve or CNS injury
    3. Pupil exam
      1. Evaluate for pupil size and reactivity
      2. Swinging Flashlight Test
      3. Tear drop shaped pupil suggests Globe Rupture
    4. Anterior chamber exam
      1. Fluorescein stain for Corneal Epithelial Disruption
      2. Evert upper eyelid to observe for Eye Foreign Body
      3. Findings
        1. Foreign body
        2. Corneal Abrasion or Laceration
        3. Hyphema
    5. Extraocular movement
      1. Upward gaze problem suggests orbital floor Fracture
    6. External eye findings
      1. Eyelid ecchymosis
      2. Proptosis
      3. Trismus suggests lateral orbital wall Fracture
      4. CN 5-2 Paresthesias suggests orbital floor Fracture
    7. Funduscopic Exam (Red Reflex)
      1. Altered Red Reflex suggests serious Eye Injury
    8. Specific tests
      1. Seidel Test (evaluation of Globe Rupture)
  4. Evaluation: Red Flags (require immediate ophthalmology evaluation)
    1. Sudden decrease in Visual Acuity
    2. Visual field defect
    3. Painful extraocular movements
    4. Photophobia
    5. Diplopia
    6. Proptosis
    7. Light Flashes or Floaters
    8. Pupil with irregular shape (e.g. tear drop)
    9. Hyphema
    10. Lights seen with halos
    11. Suspected Globe Rupture (e.g. broken eyeglasses)
    12. Medial canthus injury
  5. Prevention
    1. See Eye Protection
  6. References
    1. Naradzay (2006) Med Clin N Am 90:305
    2. Pokhrel (2007) Am Fam Physician 76:829

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