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Eye traumas

20 March 2018

What they are

Eye traumas are a rather frequent occurrence. The eye is the third part of the body to be most involved in traumas after hands and feet. Fortunately, the incidence of serious ocular traumas is not very high, so much so that a good percentage of them is resolved without hospitalisation. They most frequently affect men between the ages of 20 and 40. Of course, children up to the age of 14 are particularly at risk during play activities. Most of the traumas that men suffer occur outdoors (during work, sports, gardening and do-it-yourself activities); for women, however, the potentially most dangerous place is their home. Even falls, whether accidental or following pathologies, can cause serious eye trauma, especially in the elderly. Finally, there are cases of eye traumas resulting from road accidents, in particular if the eyeball comes into contact with metal or glass fragments or if the head hits violently against the steering wheel (generally when not wearing a seat belt), resulting in fractures of the orbital floor.
Ocular traumas are an important cause of loss of vision in one eye and, therefore, of even severe impairment; therefore, they can have great social, psychological and economic importance. They are also the main cause of blindness in one eye for young people. Therefore, their prevention is essential.

Classification

a) Blunt traumas. In turn, they must be distinguished into direct (the blunt instrument hitting the eye directly) and indirect (the bone structures near the eyeball being damaged or a trauma due to a kickback). Bruises of the eyeball are quite common, and their effects depend on the violence of the trauma. We can have mild cases, with the presence of subconjunctival haemorrhages and corneal abrasions. Or there may be more serious cases, such as the following: haemorrhages in the anterior chamber (traumatic hyphema), cause of possible further complications such as secondary glaucoma and corneal haematosis; breakdown of the muscle that controls pupil dilation (possible feeling of dazzle and trouble focusing); detachment of the iris (it moves, usually partially, from its natural anatomical site, with possible displacement of the pupil or it can give double vision, creating another slit that allows the light to filter in); damage to the lens (subluxation or luxation); vitreous haemorrhage (haemovitreus); Berlin's oedema (accumulation of fluid inside the retina, in the central area, which usually heals because it is reabsorbed); macular haemorrhage (i.e. of the centre of the retina); ruptures of the choroid; ruptures or peripheral disconnection of the retinal tissue (retinal displacement or dialysis).
Especially following aggression it is easy to find, in addition to the signs of ocular trauma, a concomitant fracture of the bone structures of the orbit, which could block the movement of the eye muscles and cause double vision (diplopia).
Eye trauma is also the leading cause of retinal detachment in young people. The most serious case of blunt pathology, especially direct, is however the bursting of the eyeball.
b) Perforating traumas. Damages at the ocular level have a very broad spectrum, ranging from minimal perforations or linear injuries of the eyeball to large lacerations, with disruption of the entire ocular architecture. We can have: corneal, scleral, ciliary body wounds and lacerations; displacement of the iris from its seat (iris prolapse); traumatic cataract; vitreous haemorrhage (haemovitreus); endophthalmitis; retinal detachment; sympathetic ophthalmia (type of uveitis, called total granulomatous, impacting the eye not affected by the trauma even after some time from the event. It is an ocular inflammation).

What should be done after having suffered a blow to the eye

In case of ocular trauma, especially if rather violent, it is always good to be checked promptly by an ophthalmologist, possibly by going to an (ophthalmic) emergency care facility. Often after an accident there are not immediately obvious signs of an eye problem but, without immediately checking with a specialist, who can rule out any damage, there is the risk of compromising complete recovery. In case of suspected corneal trauma (abrasion or scratches) it is advisable not to wait for the eye to become swollen, very red or painful, but to promptly go to an ophthalmologist (also in an ophthalmic emergency care facility), otherwise there is a risk that the lesion gets infected (especially if it is quite deep and/or extensive).
If the eyes have come into contact with toxic substances, it is necessary to wash the part immediately with plenty of cold water and rinse well, in order to clean up any residues of the substance, and then seek the help of a specialist.
If, after any ocular trauma, even in the absence of major lesions visible from the outside, a qualitative or quantitative alteration of vision is noted, the problem must never be underestimated, by waiting for it to go away, but it is necessary to undergo an eye check to make sure that the eye is actually fine.
The therapy involves the instillation of eye drops with anti-inflammatory and/or antibiotic properties, in order to avoid possible infections, and eye drops with a lubricating and tissue healing action.

How to prevent eye traumas

A good rule of thumb to prevent eye traumas is certainly to carry out any activity with the greatest possible attention, by protecting ocular integrity with adequate devices. If using sharp or pointy objects or objects that can release splinters, it is necessary to always wear a suitable protective mask for the eyes or protective goggles in accordance with the law.
It is also necessary to always prevent children (notoriously unaware of the danger) from coming into contact with objects equipped with springs, which could easily hit the eyes if not used correctly, or with sharp toys, especially if not suitable for their age. Particular caution should be applied in sporting practices involving contact with other players (for example boxing or karate) or with objects (ball hits in soccer, tennis ball injuries, etc.). According to a study conducted in the United States—published in 2016 in the journal Jama Ophthalmology—among the sports practiced in the United States, the most dangerous for the eyes are basketball, baseball and air pistol shooting.

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