Makindo Medical Notes

Eye trauma is a major cause of preventable visual loss worldwide. It ranges from minor abrasions to vision-threatening globe rupture or chemical burns. Initial management in the emergency setting is crucial: early recognition, protection of the eye, and urgent referral when needed.

🔎 Clinical Features

• Pain: Mild in abrasions, severe in penetrating injuries or chemical burns.
• Redness & Tearing: Common across almost all trauma types.
• Photophobia: Especially with corneal abrasions and burns.
• Decreased Vision: Worrisome in globe rupture, hyphema, or orbital fractures.
• Visible Damage: Foreign bodies, lacerations, blood in anterior chamber.
• Swelling/Bruising: Blunt trauma, orbital fractures.

🧪 Investigations

• Fluorescein staining: Corneal abrasions/foreign bodies.
• Slit-lamp exam: Essential for anterior chamber, cornea, and conjunctiva.
• CT orbit: Blunt trauma, orbital fracture, suspected foreign body.
• Visual acuity: Always record baseline vision.
• IOP measurement: Useful in hyphema, avoid in suspected rupture.

⚡ Types of Trauma

🚨 Red Flags

• Sudden vision loss
• Penetrating injury / suspected rupture
• Chemical burn – irrigate immediately
• Hyphema with raised IOP
• Orbital fracture with diplopia

🩺 General Management Principles

• Protect the eye with a shield (not pressure patch).
• Irrigate chemical burns immediately before referral.
• Record baseline VA in all cases.
• Give tetanus prophylaxis where indicated.
• Refer early to ophthalmology if uncertain.

💡 Pearls & Pitfalls

• Always distinguish monocular vs binocular visual disturbance – trauma may mask refractive/neurological causes.
• Never measure IOP in suspected globe rupture.
• Alkali burns penetrate deeper and are more destructive than acids.
• Even “minor” abrasions in contact lens wearers → cover for Pseudomonas.