Blunt Trauma to the Eye(s)
As we go about our daily activities, apart from sand particles in the eye or chemical substances, we may be faced with a more impacting physical injury to the eye. There are various ways these injuries may occur. Examples include; a fist blow to the eyes, a slap on the face, a terrible fall, a hit from a sports ball (football, soccer ball, tennis ball) or the forceful impact of an airbag on the face.
All these scenarios can cause sight threatening damage to the globe, its surrounding and internal tissues and many times, the bony structures around the eyes.
Symptoms of Blunt Trauma
• Swelling of the eyelids (Edema)
• Double Vision (Diplopia)
• Blurred and Reduced Vision
• Increased sensitivity to light (Photophobia)
• Possible bleeding (internal or external)
Depending on the severity, blunt trauma to the eyes may lead to other conditions. Let’s consider some:
1. Blood spots on the white part of the eye (Subconjunctival Haemorrhage):
The eye is richly supplied with blood vessels and impact to the eye may cause one or more of these vessels to burst or rupture causing blood to leak out of the vessels and on to the white part of the eye (sclera). This condition is hardly sight threatening and could occur as a result of something as simple as sneezing or chewing hard substances like meat bone.
2. Swelling of the Iris of the eye (Traumatic Iritis): Trauma to the iris can cause it to become severely inflamed. The Iris is the black part of the eye. It is saddled with the responsibility of controlling the amount of light that enters the eye. When inflamed, pain and increased sensitivity to light are observed.
3. Eyelid cuts/tears, Laceration of the globe and a Black eye:
A black eye is often the result of blood seeping or leaking under the skin of the eyelid (particularly the lower lid), causing a reddish, and later on, dark blue discolouration. This may only be noticed about 24hrs following trauma to the eyes. A tear on the globe is also a possibility. Depending on the extent of the laceration, fluid (blood and aqueous or vitreous) may leak out.
4. Dislocation or Dislodgement of the lens (Subluxation): Trauma to the face (such as a hard slap) could lead to a displacement of the lens from its position thereby interfering with vision and causing pain.
5. Blood seeping into the Anterior Chamber of the eye (Hyphema): Trauma could cause blood to accumulate in the anterior part of the eye (between the cornea and the black eye i.e. the iris) and block the visual axes leading to partial or total blockage of vision.
6. Fracture of the bones surrounding the eye (Orbital Blowout Fracture): This is when the traumatic impact on the eye causes one or more of the bones surrounding the eye to break causing pain, diplopia and restriction of eye movements especially when eye muscles are involved.
7. Retinal Detachment: Blunt trauma could cause a part of the retina to forcefully detach from its underlying surface. This may result in the individual seeing flashes of light or objects floating around inside the eyes.
8. Increased Intraocular Pressure: Pressure levels may build up within the eye following trauma. If undetected, it could damage the nerves causing irreversible loss of vision (Glaucoma).
FIRST AID FOR BLUNT TRAUMA TO THE EYE
The following steps can be taken before or while on the way to the hospital;
When a blunt object hits the eyes, within the first 24 hours, the victim should place an ice pack or cold compress over the eyes to reduce discomfort and pain. After 24 hours, a warm compress is the best option to help diffuse the blood. This is ideal for a black eye situation.
In the event of a Sub Conjunctival Haemorrhage, it is often self-limiting (it resolves on its own without any treatment). A cold compress over the eyes could help in the reabsorption of the blood. However, it must be properly diagnosed by a professional. A Subconjunctival haemorrhage may be a sign of a sight-threatening condition.
When pain and increased sensitivity to light are noticed by the victim, sunglasses should be worn to reduce the amount of light that enters the eye.
Ensure that the patient is seated upright with the eyes above the heart level when there is blood accumulated in the anterior part of the eye (hyphema). Do not lie flat.
Where there is a fracture to the orbit, place an ice pack on the eyes and sit upright. Eyes must be elevated and immediate medical attention should be sought. Do not take any Nonsteroidal anti-inflammatory drugs e.g. Aspirin. It could worsen the injury. Try not to sneeze or blow your nose because it could cause more damage.
Ensure you are examined by a professional even when there may be no serious visible injury after blunt trauma. There could be internal bleeding without any accompanying pain.
Do not apply pressure to the eye or globe.
Do not rub or scratch the eyes.
Do not apply any eye drop or medication not prescribed by a doctor.
Where there is bleeding, do not take any Non-steroidal anti inflammatory drugs (NSAIDs) such as Aspirin because they could worsen bleeding.
If the object is stuck in the eye, do not remove it. Keep it stationary while on the way to a health facility by using a paper cup taped over the affected eye.
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Remember ”A stitch in time saves nine for eye emergencies”