From the Guidelines
Blunt eye trauma management requires immediate assessment and interventions based on injury severity, with a multidisciplinary approach involving experienced ophthalmologists and other specialists as necessary 1. The management of blunt eye trauma involves several key steps to minimize morbidity, mortality, and improve quality of life.
Initial Assessment and Management
- Initial management includes rest, ice application for 15-20 minutes several times daily to reduce swelling, and elevation of the head to minimize edema.
- Analgesics such as acetaminophen (500-1000mg every 6 hours) or ibuprofen (400-600mg every 6-8 hours) can help control pain.
Ophthalmologic Evaluation and Intervention
- More severe injuries require prompt ophthalmologic evaluation by an experienced ophthalmologist, as the diagnosis and management of strabismus caused by ocular trauma require specialized training and clinical judgment 1.
- Topical antibiotics like erythromycin ointment or moxifloxacin drops may be prescribed to prevent infection.
- For significant corneal abrasions, cycloplegic agents such as cyclopentolate 1% or homatropine 5% can reduce pain from ciliary spasm.
Specific Considerations
- Patients with hyphema (blood in the anterior chamber) should avoid aspirin and NSAIDs due to bleeding risk and may require bed rest with head elevation at 30-45 degrees.
- Intraocular pressure should be monitored, with medications like timolol 0.5% drops twice daily or oral acetazolamide 250mg four times daily if elevated.
- Severe cases with globe rupture, retinal detachment, or lens dislocation require immediate surgical intervention.
Follow-Up and Prevention of Complications
- All patients should be advised to avoid rubbing the eye and to wear protective eyewear during healing.
- Follow-up within 24-48 hours is essential to monitor for complications such as secondary glaucoma, cataract formation, or retinal damage. A multidisciplinary approach, including consultation or co-management with comprehensive ophthalmology, oculoplastics, neuro-ophthalmology, and other specialties, may be necessary depending on the circumstances of the injury and the timing of the strabismus evaluation 1.
From the Research
Management of Blunt Eye Trauma
The management of blunt eye trauma involves a thorough assessment and examination to prevent further damage and preserve visual capacity 2. The following steps are crucial in managing blunt eye trauma:
- Address any life-threatening conditions first 3
- Conduct a focused history and exam, starting externally 3
- Determine the type and severity of the injury, which may include chemical injury, orbital fractures, open globe, traumatic hyphema, retinal detachment, traumatic optic neuropathy, and eyelid laceration 3, 4
- Provide basic management for common and serious eye injuries, such as:
- Corneal abrasions: apply cycloplegic medication, antibiotic ointment, and a patch (unless a corneal ulcer is suspected) 5
- Iritis: treat with cycloplegics and topical corticosteroids 5
- Hyphemas: treat with bed rest, topical atropine sulfate drops, and topical corticosteroids, as well as measures to prevent rebleeding 5
- Lid lacerations: repair with care to preserve proper functioning of the lid 5
- Ruptures of the globe: require surgical repair and long-term follow-up 5
Referral Pathways
Referral to an ophthalmologist is crucial in cases of suspected serious eye injuries, such as open globe, orbital fractures, or retinal detachment 2, 3, 4. Telemedicine may be a practical option for areas where ophthalmology coverage is lacking 3. Accurate history-taking and astute observation are paramount for timely treatment or referral that may prevent blindness 4.
Prevention
Patient education and prevention by use of protective polycarbonate eyewear are highly recommended to reduce the risk of ocular trauma 6.