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

Type	Clinical Features	Investigations	Management
Corneal Abrasion	Sharp pain, FB sensation Redness, tearing, photophobia Often scratch or contact lens history	Fluorescein staining, VA testing	Lubricants, topical antibiotic Avoid contact lenses until healed
Blunt Trauma (Orbital Fracture)	Periorbital bruising/swelling Diplopia, restricted EOMs “Blow-out” fracture → trapped muscle	CT orbit, IOP measurement, VA testing	Cold compress, analgesia Surgery for muscle entrapment Ophthalmology/maxfax referral
Penetrating Injury	Severe pain, ↓ vision Visible laceration/FB Possible globe rupture	CT orbit (no pressure, no IOP check)	Shield eye, avoid manipulation Urgent surgical repair IV antibiotics, tetanus prophylaxis
Foreign Body	Sensation of FB, tearing, redness Visible object on cornea/under lid	Slit-lamp with fluorescein	Irrigation or removal under slit-lamp Topical antibiotics + lubricants
Chemical Burns	Severe pain, redness, photophobia Epithelium sloughing Alkali worse than acid burns	pH testing, slit-lamp exam	Immediate irrigation 15–30 min Check pH until neutral Urgent ophthalmology referral
Hyphema	Blood in anterior chamber ↓ vision, photophobia Often blunt trauma	Slit-lamp, IOP measurement	Head elevation, avoid NSAIDs Monitor IOP Hospitalisation if severe

🚨 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.

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Eye Trauma