Ophthalmic trauma occurs in many settings and manifests in many ways, with widely different degrees of severity. It can result in a broad range of permanent problems, including mild to total visual loss in one or both eyes, temporary or persistent diplopia, minor to severe cosmetic abnormalities of the eyes and face, and ocular or periocular pain.
Patients with ophthalmic trauma may be of any age and either sex, and may have any extent of preexistent abnormality of the eyes, eyelids, or orbits. Their injuries may be confined to the eyes or associated with facial, head, or other potentially life-threatening injuries. Commonly the patients are fully conscious and aware of their circumstances and surroundings, but they may be affected by drugs, alcohol, or psychiatric disease. In cases of severe trauma with head injury, including when elective sedation and ventilation have been undertaken to manage cerebral injury, or when sedation has been required for other reasons, such as intubation and ventilation for airway compromise in facial injuries or severe chest injury, they may be unconscious and unresponsive.
Initial evaluation of a patient with ophthalmic trauma is frequently undertaken by a paramedic at the scene of the incident, or in an emergency room by a triage nurse or physician, who primarily is responsible for assessing the injured person's overall condition, identifying any potentially life-threatening problems that require priority treatment. Once the management of any immediately life-threatening injuries has been determined, and the patient's general condition has been stabilized, the ophthalmic injuries can be assessed, either by emergency room staff or an ophthalmologist depending upon the circumstances.
It is essential to establish as precisely as possible the circumstances and mechanism of injury and any preexisting ophthalmic abnormality, not only to optimize the ophthalmic care but also in case of subsequent legal action for personal injury. Surprisingly frequently the crucial history of hammering metal on metal, from which penetrating injury needs to be assumed until proven otherwise, is missed. Particularly if the patient is unconscious or unable to provide enough information, persons present at the time of the injury or when the patient was found, including paramedics, should be questioned about the circumstances, and family members or friends should be asked about any preexisting ophthalmic condition.
Cooperative patients should be questioned about any subjective change in vision of either eye, pain, including foreign body sensation that would suggest ocular surface abnormality including corneal or subtarsal foreign body, or corneal abrasion, and tetanus immunization status, which might also be obtainable from a family member, especially for children.
Although it is vitally important to obtain as much information as possible about vision, ocular motility, pupillary function, and any structural damage to the eyes and periocular tissues, it is crucial that examination does not exacerbate any ocular damage, a particular example being pressure ...