Ocular trauma, which occurs in many different circumstances and by a variety of mechanisms, is an important cause of avoidable severe visual impairment at all ages, and it is the leading cause of monocular blindness in young adult men in the United States. Thorough but safe clinical assessment, supplemented when necessary by imaging, is crucial to effective management. Ocular damage and the possible need for early assessment by an ophthalmologist need to be borne in mind in the assessment of any patient with mid-facial injury.
et al. Ocular trauma: A tertiary hospital experience from Oman. Oman J Ophthalmol. 2017 May–Aug;10(2):63–9.
et al. Primary prevention of ocular injury in agricultural workers with safety eyewear. Indian J Ophthalmol. 2017 Sep;65(9):859–64.
et al. The prevalence of vision loss due to ocular trauma in the Australian National Eye Health Survey. Injury. 2017 Nov;48(11):2466–9.
et al. Epidemiology of open-globe injuries in Hong Kong. Asia Pac J Ophthalmol (Phila). 2017 Jan–Feb;6(1):54–8.
et al. Ocular traumas in working age adults in Finland—Helsinki Ocular Trauma Study. Acta Ophthalmol. 2017 May;95(3):288–94.
et al. Systematic analysis of ocular trauma by a new proposed ocular trauma classification. Indian J Ophthalmol. 2017 Aug;65(8):719–22.
et al. Epidemiology and clinical characteristics of patients hospitalized for ocular trauma in South-Central China. Acta Ophthalmol. 2017 Sep;95(6):e503–10.
1. CONJUNCTIVAL & CORNEAL FOREIGN BODIES
If a patient complains of “something in my eye” and gives a consistent history, a foreign body is usually present on the cornea (eFigure 7–73) or under the upper lid even though it may not be visible. Visual acuity should be tested before treatment is instituted, to assess the severity of the injury and as a basis for comparison in the event of complications.
Corneal rust stain from iron foreign body (arrow). (From James J Augsburger and Zélia M Corrêa. Reproduced, with permission, from Riordan-Eva P, Augsburger JJ. Vaughan & Asbury’s General Ophthalmology, 19th ed. McGraw-Hill, 2018.)
After a local anesthetic (eg, proparacaine, 0.5%) is instilled, the eye is examined with a slit lamp or with a hand flashlight, using oblique illumination, and loupe. The instillation of sterile fluorescein may make corneal foreign bodies more apparent, which are then removed with a sterile wet cotton-tipped applicator or hypodermic needle. Bacitracin-polymyxin ophthalmic ointment should be instilled. It is not necessary to patch the eye. All patients need to be advised to return promptly for reassessment if there is any increase in pain, redness, or impairment of vision.
Iron foreign bodies usually leave a ...