What is the treatment for blunt trauma to the eye?

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Treatment for Blunt Trauma to the Eye

Patients with high-velocity eye injuries, penetrating eye injuries, irregular pupil after trauma, eye bleeding after trauma, or loss of vision after trauma should seek immediate medical attention. 1

Initial Assessment and Management

First Aid Measures

  • Avoid rubbing the injured eye 1
  • Protect the eye by taping a hard plastic eye shield, paper cup, or plastic cup over the eye to prevent unintentional touching 1
  • For minor discomfort, over-the-counter oral acetaminophen or NSAIDs may be used 1

Immediate Evaluation

  • Visual acuity testing under standard ophthalmic lighting conditions, with and without correction
  • Pinhole testing and manifest refraction to assess best-corrected visual potential 1
  • External examination to assess:
    • Evidence of proptosis, ptosis, or lagophthalmos
    • Lid or facial asymmetry, scarring, and malfunction
    • Pupil responses and corneal diameter 1

Specific Injury Assessment and Treatment

Corneal Injuries

  • Evaluate for:
    • Epithelial breakdown
    • Stromal infiltration
    • Focal thickening or thinning
    • Scarring 1
  • Treatment:
    • Topical antibiotics to prevent infection
    • Cycloplegics to reduce ciliary spasm and pain
    • Avoid patching if epithelial defect present

Hyphema (Blood in Anterior Chamber)

  • Bed rest with head elevation 30-45 degrees
  • Eye shield protection
  • Avoid antiplatelet medications
  • Monitor intraocular pressure
  • Surgical evacuation if pressure remains elevated or blood fails to clear

Lens Injuries

  • Assess for subluxation or dislocation
  • Surgical intervention if lens is dislocated or causing secondary glaucoma

Retinal Injuries

  • Dilated fundus examination to detect:
    • Retinal tears or detachment
    • Commotio retinae (Berlin's edema)
    • Choroidal rupture
  • Prompt referral to retina specialist for tears or detachment

Globe Rupture

  • Immediate ophthalmologic consultation
  • No pressure on the eye
  • Eye shield protection (no patching)
  • NPO status in preparation for possible surgery
  • Systemic antibiotics
  • Tetanus prophylaxis if indicated

Special Considerations

Traumatic Optic Neuropathy

  • High-dose corticosteroids may be considered
  • Surgical decompression in selected cases

Orbital Fractures

  • CT scan for evaluation
  • Surgical repair for:
    • Significant enophthalmos
    • Persistent diplopia
    • Muscle entrapment

Follow-up Care

  • Regular monitoring for delayed complications:
    • Secondary glaucoma
    • Cataract formation
    • Retinal detachment
    • Sympathetic ophthalmia

Common Pitfalls to Avoid

  1. Failing to recognize high-risk injuries requiring immediate specialist attention
  2. Rubbing the eye after injury, which can worsen damage 1
  3. Using eye patches in cases of corneal abrasion, which can delay healing
  4. Missing peripheral retinal tears that can lead to later detachment
  5. Underestimating the potential for delayed complications after seemingly minor trauma 2

Remember that blunt trauma can cause a wide range of ocular injuries, and potentially severe injuries can be harbored in the recesses of the angle or far periphery of the retina. Even when one eye has more obvious signs of injury, always examine the fellow eye thoroughly 2.

References

1
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

2
Research

The ocular sequelae of blunt trauma.

Advances in ophthalmic plastic and reconstructive surgery, 1987

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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