- Matthew F Gardiner, MD
Matthew F Gardiner, MD
- Assistant Professor of Ophthalmology
- Harvard Medical School
- Carolyn E Kloek, MD
Carolyn E Kloek, MD
- Instructor in Ophthalmology
- Harvard Medical School
- Section Editors
- Richard G Bachur, MD
Richard G Bachur, MD
- Section Editor — Pediatric Trauma
- Professor of Pediatrics and Emergency Medicine
- Harvard Medical School
- Maria E Moreira, MD
Maria E Moreira, MD
- Section Editor — Adult Trauma
- Associate Professor, Department of Emergency Medicine
- University of Colorado Denver School of Medicine
- Residency Program Director
- Denver Health Residency in Emergency Medicine
- 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
Trauma to the ocular surface often involves the conjunctiva. Mechanisms of injury to the conjunctiva include thermal and chemical burns and blunt or penetrating trauma. While injuries can be isolated to the conjunctiva, conjunctival injury can be the presenting sign of underlying intraocular trauma, including open globe injury. Careful evaluation, initial management, and triage of conjunctival injuries are essential to promote appropriate healing of the conjunctiva and other associated ocular injuries.
The approach to subconjunctival hemorrhage, conjunctival abrasions, conjunctival foreign bodies, and conjunctival lacerations will be reviewed here. The treatment of corneal abrasions and foreign bodies and ocular chemical burns are discussed separately. (See "Corneal abrasions and corneal foreign bodies: Clinical manifestations and diagnosis" and "Topical chemical burns", section on 'Eye exposure'.)
The conjunctiva is a thin, transparent tissue which covers and is adherent to the anterior portion of the sclera and lines the inside of the eyelids (figure 1).
The conjunctiva is conventionally divided into two sections:
●Bulbar conjunctiva covering the sclera
- Mimura T, Usui T, Yamagami S, et al. Recent causes of subconjunctival hemorrhage. Ophthalmologica 2010; 224:133.
- Macewen CJ. Eye injuries: a prospective survey of 5671 cases. Br J Ophthalmol 1989; 73:888.
- Ghafouri A, Burgess SK, Hrdlicka ZK, Zagelbaum BM. Air bag-related ocular trauma. Am J Emerg Med 1997; 15:389.
- Onwuzuruigbo CJ, Fulda GJ, Larned D, Hailstone D. Traumatic blindness after airbag deployment: bilateral lenticular dislocation. J Trauma 1996; 40:314.
- Sellar PW, Johnston PB. Ocular injuries due to exploding bottles of carbonated drinks. BMJ 1991; 303:176.
- Mutlukan E, Fleck BW, Cullen JF, Whittle IR. Case of penetrating orbitocranial injury caused by wood. Br J Ophthalmol 1991; 75:374.
- Yuksel M, Yuksel KZ, Ozdemir G, Ugur T. Bilateral orbital emphysema and pneumocephalus as a result of accidental compressed air exposure. Emerg Radiol 2007; 13:195.
- Jamra FA, Halasa A, Salman S. Letter bomb injuries: a report of three cases. J Trauma 1974; 14:275.
- Yip CC, Tan DT, Balakrishnan V, Choo CT. High-pressure paint gun injury to the orbit and ocular adnexa. Int Ophthalmol 1998; 22:335.
- Sakata C, Hiraoka T, Oshika T. Unusually large plastic toy as a persisting conjunctival foreign body. Jpn J Ophthalmol 2007; 51:232.
- Gerding H. Unusually long foreign body of the conjunctival fornix in a child overlooked by 3 ophthalmologists. Klin Monbl Augenheilkd 2013; 230:390.
- Ratnarajan G, Calladine D, Bird KJ, Watson SL. Delayed presentation of severe ocular injury from a button battery. BMJ Case Rep 2013; 2013.
- Taylor C, Macnab AJ. Pediatric eye injury due to Avena fatua (wild oats). Pediatr Emerg Care 2001; 17:358.
- Bord SP, Linden J. Trauma to the globe and orbit. Emerg Med Clin North Am 2008; 26:97.
- Della Vecchia MA, Jaeger EA, Markovitz BJ. Corneal and conjunctival foreign bodies. In: The Wills Eye Manual: Office and Emergency Room Treatment of Eye Disease, 5th edition, Ehlers JP, Shah CP. (Eds), Wolters Kluwer | Lippincott, Williams & Wilkins, Philadelphia 2008. p.16.
- Rhee, DJ. The Wills Eye Manual: Office and Emergency Room Diagnosis and Treatment of Eye Disease, 3rd, Lippincott Williams & Wilkins, Philadelphia 1999.
- Shingleton, BJ, Hersh, PS, Kenyon, KR. Eye Trauma, Mosby Year Book, St. Louis 1991.
- Pokhrel PK, Loftus SA. Ocular emergencies. Am Fam Physician 2007; 76:829.
- PERTINENT ANATOMY
- CLINICAL FEATURES
- Subconjunctival hemorrhage
- Conjunctival abrasion
- Conjunctival laceration
- Conjunctival foreign body
- PRIMARY EVALUATION AND MANAGEMENT
- Initial assessment
- Diagnostic tests
- INDICATIONS FOR OPHTHALMOLOGIC CONSULTATION OR REFERRAL
- - Subconjunctival hemorrhage
- - Conjunctival abrasion or laceration
- - Conjunctival foreign body
- SUMMARY AND RECOMMENDATIONS