Management of Eye Injury from Blunt Trauma
Immediate ophthalmologic examination is mandatory for all blunt eye trauma to identify vision-threatening injuries, as serious damage can be harbored in the angle, periphery, or posterior segment even when external signs appear minimal. 1
Initial Assessment and Triage
Perform systematic examination of both eyes immediately, as the contralateral eye may harbor less obvious but serious injuries that threaten vision. 1 Document the status of each eye carefully for future reference, particularly in patients with associated head trauma. 2
Critical Structures to Evaluate
Examine specifically for injuries that threaten vision:
- Anterior chamber: Look for hyphema (blood in anterior chamber), which requires specialized management 1, 3
- Lens: Assess for traumatic cataract, subluxation, or dislocation 4, 2
- Angle structures: Damage here can cause elevated intraocular pressure with long-term consequences 1
- Macula and peripheral retina: Check for choroidal rupture, retinal tears, or detachment 1, 3
- Optic nerve: Evaluate for contusion or traumatic optic neuropathy 4, 2
- Globe integrity: Rule out rupture before proceeding with further examination 4, 5
Management Algorithm
Injuries Manageable by Primary Care Physician
Simple presentations can be managed in the office setting:
- Eyelid ecchymosis without globe involvement 3
- Subconjunctival hemorrhage without other pathology 3
- Superficial corneal epithelial scratches 2
Injuries Requiring Immediate Ophthalmology Referral
Refer immediately for any of the following:
- Hyphema (blood in anterior chamber) 1, 3
- Elevated intraocular pressure 1
- Lens subluxation, dislocation, or traumatic cataract 4, 2
- Vitreous hemorrhage 4
- Retinal tears or detachment 1, 4
- Suspected globe rupture 4, 5
- Blow-out orbital fracture 2
- Eyelid lacerations involving the globe or canalicular system 4
- Any inability to complete full examination due to hemorrhage or structural damage 1
Critical Pitfalls to Avoid
Never assume minimal external signs indicate minor injury, as potentially severe damage can exist in the angle recesses or far retinal periphery. 1
Do not delay ophthalmologic consultation when serious injury is suspected, as early treatment of retinal tears and elevated intraocular pressure prevents severe vision loss. 1
Always examine the fellow eye thoroughly, even when one eye shows more obvious injury, as bilateral trauma with asymmetric presentation is common. 1
Long-Term Considerations
Sustained follow-up is mandatory even after initial management, as blunt trauma has potential long-term visual consequences including delayed retinal detachment, chronic angle damage, and progressive lens changes. 1, 4 Complex injuries carry higher risk of residual functional impairment despite anatomical repair. 4