Approach to eye injuries in the emergency department
- Matthew F Gardiner, MD
Matthew F Gardiner, MD
- Assistant Professor of Ophthalmology
- Harvard Medical School
- Ankoor Shah, MD, PhD
Ankoor Shah, MD, PhD
- Section Editors
- Susan B Torrey, MD
Susan B Torrey, MD
- Section Editor — Pediatric Resuscitation; Pediatric Trauma
- Director, Division of Pediatric Emergency Medicine
- Associate Professor of Emergency Medicine and Pediatrics (Clinical)
- NYU School of Medicine
- Jonathan Trobe, MD
Jonathan Trobe, MD
- Section Editor — Ophthalmology
- Professor of Ophthalmology and Visual Sciences
- Professor of Neurology
- University of Michigan Kellogg Eye Center
- Deputy Editor
- James F Wiley, II, MD, MPH
James F Wiley, II, MD, MPH
- Senior Deputy Editor — Adult and Pediatric Emergency Medicine
- Senior Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Professor of Pediatrics and Emergency Medicine/Traumatology
- University of Connecticut School of Medicine
This topic provides an approach to eye injuries. An overview of eye injuries and evaluation and management of selected injuries are discussed separately:
●(See "Retinal detachment".)
- Négrel AD, Thylefors B. The global impact of eye injuries. Ophthalmic Epidemiol 1998; 5:143.
- Pandita A, Merriman M. Ocular trauma epidemiology: 10-year retrospective study. N Z Med J 2012; 125:61.
- Koo L, Kapadia MK, Singh RP, et al. Gender differences in etiology and outcome of open globe injuries. J Trauma 2005; 59:175.
- Baker RS, Wilson RM, Flowers CW Jr, et al. A population-based survey of hospitalized work-related ocular injury: diagnoses, cause of injury, resource utilization, and hospitalization outcome. Ophthalmic Epidemiol 1999; 6:159.
- Kanoff JM, Turalba AV, Andreoli MT, Andreoli CM. Characteristics and outcomes of work-related open globe injuries. Am J Ophthalmol 2010; 150:265.
- United States Eye Injury Registry. http://www.useironline.org/ (Accessed on June 26, 2013).
- Kratz A, Levy J, Cheles D, et al. Airsoft gun-related ocular injuries: novel findings, ballistics investigation, and histopathologic study. Am J Ophthalmol 2010; 149:37.
- Shuttleworth GN, Galloway P, Sparrow JM, Lane C. Ocular air gun injuries: a one-year surveillance study in the UK and Eire (BOSU). 2001-2002. Eye (Lond) 2009; 23:1370.
- Ramstead C, Ng M, Rudnisky CJ. Ocular injuries associated with Airsoft guns: a case series. Can J Ophthalmol 2008; 43:584.
- Saunte JP, Saunte ME. 33 cases of airsoft gun pellet ocular injuries in Copenhagen, Denmark, 1998-2002. Acta Ophthalmol Scand 2006; 84:755.
- Kruger LP, Acton JK. Paintball ocular injuries. S Afr Med J 1999; 89:265.
- Yip CC, Tan DT, Balakrishnan V, Choo CT. High-pressure paint gun injury to the orbit and ocular adnexa. Int Ophthalmol 1998; 22:335.
- Farr AK, Fekrat S. Eye injuries associated with paintball guns. Int Ophthalmol 1998-1999; 22:169.
- Enger C, Schein OD, Tielsch JM. Risk factors for ocular injuries caused by air guns. Arch Ophthalmol 1996; 114:469.
- Sharif KW, McGhee CN, Tomlinson RC. Ocular trauma caused by air-gun pellets: a ten year survey. Eye (Lond) 1990; 4 ( Pt 6):855.
- Sheets W, Vinger P. Ocular injuries from air guns. Int Ophthalmol Clin 1988; 28:225.
- Roden D, Cleary P, Eustace P. A five-year survey of ocular shotgun injuries in Ireland. Br J Ophthalmol 1987; 71:449.
- Youn J, Sallis RE, Smith G, Jones K. Ocular injury rates in college sports. Med Sci Sports Exerc 2008; 40:428.
- Kent JS, Eidsness RB, Colleaux KM, Romanchuk KG. Indoor soccer-related eye injuries: should eye protection be mandatory? Can J Ophthalmol 2007; 42:605.
- Goldstein MH, Wee D. Sports injuries: an ounce of prevention and a pound of cure. Eye Contact Lens 2011; 37:160.
- Corrales G, Curreri A. Eye trauma in boxing. Clin Sports Med 2009; 28:591.
- Zoumalan CI, Blumenkranz MS, McCulley TJ, Moshfeghi DM. Severe surfing-related ocular injuries: the Stanford Northern Californian experience. Br J Sports Med 2008; 42:855.
- Townley D, Kirwan C, O'Keefe M. Golf--recognising the risk of severe eye injury. Ir Med J 2008; 101:167.
- Heimmel MR, Murphy MA. Ocular injuries in basketball and baseball: what are the risks and how can we prevent them? Curr Sports Med Rep 2008; 7:284.
- Capão Filipe JA, Rocha-Sousa A, Falcão-Reis F, Castro-Correia J. Modern sports eye injuries. Br J Ophthalmol 2003; 87:1336.
- Kriz PK, Zurakowski D, Almquist JL, et al. Eye Protection and Risk of Eye Injuries in High School Field Hockey. Pediatrics 2015; 136:521.
- Han SB, Yang HK, Woo SJ, et al. Association of alcohol consumption with the risk of ocular trauma. J Korean Med Sci 2011; 26:675.
- Anderson SK, Desai UR, Raman SV. Incidence of ocular injuries in motor vehicle crash victims with concomitant air bag deployment. Ophthalmology 2002; 109:2356.
- Pearlman JA, Au Eong KG, Kuhn F, Pieramici DJ. Airbags and eye injuries: epidemiology, spectrum of injury, and analysis of risk factors. Surv Ophthalmol 2001; 46:234.
- Lee WB, O'Halloran HS, Pearson PA, et al. Airbags and bilateral eye injury: five case reports and a review of the literature. J Emerg Med 2001; 20:129.
- Ball DC, Bouchard CS. Ocular morbidity associated with airbag deployment: a report of seven cases and a review of the literature. Cornea 2001; 20:159.
- Stein J, Jaeger E, Jeffers J. Air bags and ocular injuries. Am J Ophthalmol 2000; 129:702.
- Lemley HL, Chodosh J, Wolf TC, et al. Partial dislocation of laser in situ keratomileusis flap by air bag injury. J Refract Surg 2000; 16:373.
- Grisoni ER, Pillai SB, Volsko TA, et al. Pediatric airbag injuries: the Ohio experience. J Pediatr Surg 2000; 35:160.
- Duma SM, Kress TA, Porta DJ, et al. Airbag-induced eye injuries: a report of 25 cases. J Trauma 1996; 41:114.
- Kuhn F, Morris R, Witherspoon CD. Eye injury and the air bag. Curr Opin Ophthalmol 1995; 6:38.
- Kloek CE, Andreoli MT, Andreoli CM. Characteristics of traumatic cataract wound dehiscence. Am J Ophthalmol 2011; 152:229.
- Andreoli MT, Andreoli CM. Geriatric traumatic open globe injuries. Ophthalmology 2011; 118:156.
- Lord SR, Smith ST, Menant JC. Vision and falls in older people: risk factors and intervention strategies. Clin Geriatr Med 2010; 26:569.
- Hollander DA, Aldave AJ. Ocular bungee cord injuries. Curr Opin Ophthalmol 2002; 13:167.
- Kuhn F, Morris R, Witherspoon CD, Mann L. Epidemiology of blinding trauma in the United States Eye Injury Registry. Ophthalmic Epidemiol 2006; 13:209.
- Trobe J. Anatomy of the visual system. The eyes have it: an interactive teaching and assessment program on vision care. University of Michigan Kellogg Eye Center, 2009. Available at http://www.kellogg.umich.edu/theeyeshaveit/review/index.html (accessed May 19, 2014).
- Kuhn F, Morris R, Witherspoon CD. Birmingham Eye Trauma Terminology (BETT): terminology and classification of mechanical eye injuries. Ophthalmol Clin North Am 2002; 15:139.
- Harlan Jr JB, Ng EWM, Pieramici DJ. Evaluation. In: Ocular Trauma: Principles and Practice, Kuhn F, Pieramici DJ. (Eds), Thieme, New York 2002. p.53.
- Kniestedt C, Stamper RL. Visual acuity and its measurement. Ophthalmol Clin North Am 2003; 16:155.
- Russell SR, Olsen KR, Folk JC. Predictors of scleral rupture and the role of vitrectomy in severe blunt ocular trauma. Am J Ophthalmol 1988; 105:253.
- Corbett JJ. The bedside and office neuro-ophthalmology examination. Semin Neurol 2003; 23:63.
- Harlan JB Jr, Pieramici DJ. Evaluation of patients with ocular trauma. Ophthalmol Clin North Am 2002; 15:153.
- Sadun AA. Distinguishing between clinical impairments due to optic nerve or macular disease. Metab Pediatr Syst Ophthalmol (1985) 1990; 13:79.
- Hasso AN, Drayer BP, Anderson RE, et al. Orbits, vision, and visual loss. American College of Radiology. ACR Appropriateness Criteria. Radiology 2000; 215 Suppl:579.
- ACR Appropriateness Criteria. Orbits, Vision and Visual Loss, Variant 7: Head injury with vision loss. Last review 2012 https://acsearch.acr.org/docs/69486/Narrative/ (Accessed on October 08, 2015).
- INJURY CLASSIFICATION
- Open globe
- Closed globe
- Treat life-threatening injury
- Focused history
- Identify threats to vision
- EXAMINATION OF THE INJURED EYE
- Visual acuity
- Periocular examination
- - Inspect the orbit and lids
- - Evaluate lid function
- - Evaluate eyelid and periocular sensation
- - Palpate the orbital rim
- Ocular examination
- - Pupils
- - Extraocular motility
- - Anterior segment
- - Retina and optic nerve
- - Intraocular pressure measurement
- - Fluorescein staining
- Diagnostic imaging