Overview of eye injuries in the emergency department
- Matthew F Gardiner, MD
Matthew F Gardiner, MD
- Assistant Professor of Ophthalmology
- Harvard Medical School
- 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 — UpToDate
- Deputy Editor — Adult and Pediatric Emergency Medicine
- Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Clinical Professor of Pediatrics and Emergency Medicine/Traumatology
- University of Connecticut School of Medicine
This topic provides an overview of eye injuries. The approach to eye injuries and emergent evaluation and management of open globe injuries are discussed separately:
Eye injury includes trauma to the eye (ocular trauma), the orbit (periocular trauma), or both. The initial approach to eye injury, as with any trauma, must involve careful triage. Because the eyes are located near vital the intracranial space, the cervical spine, and the airway, life-threatening injuries involving these structures need to be considered prior to assessing periocular and ocular damage. (See "Initial management of trauma in adults" and "Trauma management: Approach to the unstable child".)
Once life-threatening injuries are excluded or identified and treated, the emergency clinician should identify threats to vision using a focused history and an organized approach (algorithm 1). A systematic approach to the evaluation of patients with eye injuries will lead to the rapid recognition and treatment of vision-threatening conditions including caustic eye exposures, orbital compartment syndrome (OCS), and open-globe injuries. (See "Approach to eye injuries in the emergency department", section on 'Approach'.)
- Lima V, Burt B, Leibovitch I, et al. Orbital compartment syndrome: the ophthalmic surgical emergency. Surv Ophthalmol 2009; 54:441.
- Traumatic retrobulbar hemorrhage. In: The Wills Eye Manual: Office and Emergency Room Diagnosis and Treatment of Eye Disease, 5th ed, Ehlers JP, Shah CP (Eds), Lippincott Williams & Wilkins, Philadelphia 2008. p.30.
- Sun MT, Chan WO, Selva D. Traumatic orbital compartment syndrome: importance of the lateral canthomy and cantholysis. Emerg Med Australas 2014; 26:274.
- Vassallo S, Hartstein M, Howard D, Stetz J. Traumatic retrobulbar hemorrhage: emergent decompression by lateral canthotomy and cantholysis. J Emerg Med 2002; 22:251.
- Vitreous hemorrhage. In: The Wills Eye Manual: Office and Emergency Room Diagnosis and Treatment of Eye Disease, 5th ed, Ehlers JP, Shah CP (Eds), Lippincott Williams & Wilkins, Philadelphia 2008. p.296.
- Retina. In: The Wills Eye Manual: Office and Emergency Room Diagnosis and Treatment of Eye Disease, 5th ed, Ehlers JP, Shah CP (Eds), Lippincott Williams & Wilkins, Philadelphia 2008. p.274.
- Trauma. In: The Wills Eye Manual: Office and Emergency Room Diagnosis and Treatment of Eye Disease, 5th ed, Ehlers JP, Shah CP (Eds), Lippincott Williams & Wilkins, Philadelphia 2008. p.12.
- Andrews BT, Jackson AS, Nazir N, et al. Orbit fractures: Identifying patient factors indicating high risk for ocular and periocular injury. Laryngoscope 2016; 126 Suppl 4:S5.
- Patel MM, Chee YE, Eliott D. Choroidal rupture: a review. Int Ophthalmol Clin 2013; 53:69.
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- VISION-THREATENING CONDITIONS
- Ocular chemical burns
- Orbital compartment syndrome
- - Clinical manifestations
- - Management
- Lateral canthotomy and inferior cantholysis
- Open globe injury
- Traumatic hyphema
- Vitreous hemorrhage
- Retinal trauma
- Optic nerve injury
- Periocular injuries that threaten vision
- COMMON CONDITIONS
- Eyelid lacerations
- Corneal abrasions and foreign bodies
- Conjunctival injury
- Orbital fractures
- OTHER CONDITIONS
- Lens subluxation or dislocation
- Choroidal injury