Blunt Eye Trauma

What is Blunt Eye Trauma?

Blunt eye trauma, also known as ocular trauma, is an injury to the eye or areas around the eye caused by forceful impact, injury, or physical attack with a dull object or surface. Blunt eye trauma can include damage to the eye, bones around the eye, and the eyelid. 

Ocular injuries damage the eye due to the sudden compression and indentation of the eyeball that occurs at the moment of impact.

Blunt eye trauma can lead to various complications, including:

• Globe rupture or bursting of the outer membrane of the eye.
• Retrobulbar hematoma, a condition that involves blood congestion in the soft tissue behind the eyeball.
• Retinal detachment, when trauma is forceful enough to cause the retina to detach. 
• Orbital fracture (also called a blowout fracture), when high-impact injuries are forceful enough to break the thin bones of the eye socket.
• Hyphema or bleeding in front of the eye.
• Foreign body entrapment, when a small piece of material such as metal, wood, or plastic becomes lodged inside the eye.
• Traumatic glaucoma or damage to the optical nerve.
• Corneal abrasions or cuts on the clear, protective window at the front of the eye.
• Vitreous hemorrhage or bleeding into the jelly-like filling of the back part of the eye.
• Cataract or cloudiness on the lens of the eye.

The potential consequences of blunt trauma can lead to loss of vision. Therefore, any trauma to the eye should be considered an emergency.

In 2001, an estimated 1.9 million people in the U.S. had an eye injury that required treatment in an emergency room, inpatient or outpatient facility, or private physician’s office. In 2013 there were about 5.3 million cases of foreign bodies in the eyes worldwide.

What Causes Blunt Eye Trauma?

Blunt eye trauma is caused by a sudden forceful impact to the eye. 

Common causes of blunt eye trauma include:

• Sports (especially ice hockey, soccer, softball, and baseball)
• Car accident
• Job-related injury (especially drilling, hammering, or working with cars)
• Fighting or interpersonal violence
• Falling
• Children’s games such as BB guns and firecrackers

Young men are more likely to develop blunt eye trauma. 95% of ocular trauma injuries occur in men under 30 years of age, often caused by interpersonal violence.

Blunt eye trauma is more likely to occur in the home, followed by the workplace. In older patients, blunt eye trauma is most often caused by falls. 

Symptoms of Blunt Eye Trauma

Symptoms of blunt eye trauma depend on the severity of the injury.

Common mild symptoms include:

• Minor pain
• Bruising
• Swelling
• A black eye
• Trace amounts of blood over the white part (sclera) of the eye
• Edema or buildup of fluid in the eye

Severe symptoms of blunt eye trauma that indicate a critical injury has occurred include:

• Any blood over the colored part (iris) of the eye
• Vision changes 
• Difficulty moving the eye
• Pain with eye movements
• A large amount of blood in the white part (sclera) of the eye
• A change in pupil size or shape
• Severe pain in the eyeball
• Light sensitivity
• Blurred vision
• Double vision 
• Eye deformity
• Deformity of the eye socket
• Numbness around the eye
• Abnormal upper eyelid movement
• A foreign object embedded in the eye

Blunt Eye Trauma Management

Blunt eye trauma should be treated within 4 hours from the onset of symptoms to reduce the risk of vision loss in cases of globe rupture or retrobulbar hematoma. Patients who have sustained an eye injury should seek immediate medical attention at a hospital emergency room or urgent care facility. 

An emergency department physician will examine the patient, provide a visual acuity test, and may treat superficial lacerations around the eye. Attending clinicians will consult an ophthalmologist on call to assess the eye. If there is any possibility of vision loss, patients will be referred to an ophthalmologist for additional treatment. 

The ophthalmologist or healthcare provider will gather information from the patient or witnesses on how the trauma occurred in order to determine the best possible treatment to provide. The doctor may use a slit lamp to examine the eye, including the cornea and optic nerve, and assess the damage. The doctor may take CT scans or X-Rays to rule out an orbital bone fracture and look for any corneal foreign body.

If the doctor diagnoses a retinal tear, detachment, or a globe rupture, immediate surgery or laser treatment may be needed to prevent permanent vision loss. 

Sometimes the consequences of an eye injury may not become noticable for months or years after the damage occurs. These late effects, including cataract, retinal detachment, or glaucoma, all may result in vision loss. Therefore, continued follow-up care is essential to preserve vision after an injury.

Treatment For Blunt Eye Trauma 

Treatment of blunt trauma depends entirely on the extent of the injury.

Treatment for mild blunt eye trauma includes:

• Ice packs
• Pain medicine
• Reducing physical activities until the eye is healed

Treatment for severe cases of blunt eye trauma will also include:

• Steroid eye drops to reduce inflammation
• Glaucoma eye drops to reduce intraocular pressure
• Antiemetics or anti-nausea medication
• Antibiotic ointment
• Wearing protective eyewear until the eye is healed
• Surgery
• Follow up eye examinations
• Bed rest
• Avoiding aspirin and ibuprofen which can increase the risk of re-bleeding

Common Questions and Answers