Ocular Trauma

Ocular injury is a significant contributor to preventable morbidity on a global scale and a leading cause of unilateral vision loss. This term encompasses a range of physical or chemical harms to the eye, which have the potential to affect or impair vision, ultimately posing a risk of blindness.

Eye injuries can result from various causes, including mechanical, chemical, radiation, electrical, or thermal sources.

Mechanism in Blunt Injury:

• Blunt trauma causes ocular damage by the coup mechanism and the contre-coup mechanism.
• Coup: Local trauma at the site of impact, leading to conditions such as corneal abrasion.
• Contre-coup: Injuries at the opposite side of the eye caused by shock waves traversing the eye and striking the posterior pole, as seen in commotio retinae.
• Anteroposterior Compression and Horizontal Expansion: Pressure waves in the anteroposterior and horizontal axes, contributing to conditions like globe rupture.

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Lid:

• Periocular Ecchymosis, Hematoma, Panda Eye
• Lid Laceration: Margin, Canaliculus, Extensive Tissue Loss

Orbit:

• Orbital Wall Fractures

Conjunctiva:

• Subconjunctival Hemorrhage
• Conjunctival Congestion
• Foreign Body of Conjunctiva
• Conjunctival Tear

Cornea:

• Epithelial Damage
• Corneal Edema
• Descemet Membrane Tear
• Recurrent Corneal
• Corneal Tear: Partial or Lamellar or Full-Thickness Tear

Sclera:

• Partial Thickness or Full-Thickness Tear with or without Vitreous Prolapse
• Foreign Body Can Be Lodged in the Sclera
• The Direction of Trauma Also Determines the Site of the Tear: The Sclera Usually Gives Way at the Site of Old Manual Small Incision Cataract Surgery Incision in Case of Inferior Blunt Trauma

Anterior Chamber

• Hyphema: Can result from a blunt trauma from the iris root or ciliary body.
• Hyphema Consequences: Can result in raised IOP and manifest as optic neuropathy and corneal endothelial staining.
• Anterior Chamber Exudates and Fibrinous Membrane: Can also be seen due to traumatic uveitis.

Iris, Pupil, and Ciliary Body:

• Iridodialysis: Separation of the iris root from the ciliary body.
• Iris Stromal Tears: Tears in the iris stromal tissue.
• Traumatic Mydriasis:
• Traumatic Miosis:
• Ciliary Body Detachment: Results in ciliary body shutdown and hypotony.
• Angle Recession: Separation of longitudinal muscle fibers from circular muscle fibers of the ciliary body.

Lens:

• Cataract
• Subluxation: Can result from zonular dialysis or damage to suspensory ligaments.
• Dislocation: Occurs when the zonular fibers are completely damaged.

Vitreous:

• Vitreous Hemorrhage: Can be seen in association with posterior vitreous detachment. Pigmentary cells floating in the vitreous, also called tobacco dust, can be noticed.
• Vitreous Detachment
• Vitreous Opacities: Liquefaction of vitreous can occur, leading to the presence of clouds of opacities.
• Vitreous Prolapse: Can occur in the anterior chamber associated with subluxated or dislocated cataracts.

Optic Nerve:

• Optic Nerve Avulsion: A rare condition with a poor visual prognosis; there is no treatment.
• Traumatic Optic Neuropathy: Can result from blunt head or orbital trauma. Patients usually present with sudden vision loss, and there may be a relative afferent pupillary defect (RAPD) with color vision defects.

Choroid:

• Choroidal Rupture: Typically temporal to the optic disc, with a circular shape. It may be associated with pigmentation at the margins.
• Choroidal Hemorrhage: Can be observed under the retina, or blood may enter the vitreous in the case of a retinal tear.
• Choroidal Detachment: Kissing choroidals can be observable in cases of blunt trauma.
• Traumatic Choroiditis: Patches of depigmentation and discoloration may be visible.

Retina:

• Berlin's Edema (Commotio Retinae): Typically presents as a cherry spot at the fovea, resulting in milky white cloudiness at the posterior pole.
• Retinal Tear: [Include additional information]
• Retinal Detachment: May manifest after blunt trauma in eyes with retinal tears or vitreoretinal traction.
• Traumatic Proliferative Retinopathy: Occurs in cases with vitreous hemorrhage.
• Retinal Hemorrhage: Can be flame-shaped or boat-shaped.

Macula:

• Macular Edema: Due to concussion injury after blunt trauma.
• Pigmentary Degeneration: Usually observed in long-standing cases after blunt eye trauma.
• Macular Hole: Traumatic macular holes can be seen after blunt eye trauma.
• Macular Scar: Macular scars can also be seen after blunt eye trauma.

• Visual Acuity
• Pupillary Reaction
• Intraocular Pressure
• Gonioscopy
• Fluorescein Staining
• Extraocular Motility
• Thorough Slit-Lamp Examination

Imaging:

• B Scan Ultrasonography
• Computed Tomography
• Magnetic Resonance Imaging

Treatment:

• Medical
• Surgical