Ocular Trauma: Urgent Eye Injury Management by Expert Eye Doctors

Types of Ocular Trauma and What to Expect

Corneal Abrasion

A corneal abrasion is one of the most common types of ocular trauma. It occurs when the smooth, transparent surface of the eye (the cornea) suffers a minor injury due to a scratch or foreign object. In many cases, the epithelium heals naturally in a few days; however, treatment is still important to avoid complications.

• Exam Findings: The epithelium shows a defect that stains with fluorescein dye (NaFl), but there is generally no deeper infiltration.
• Treatment: Prophylactic antibiotic drops or ointments are prescribed to prevent infection. In some cases, if the wound is sterile and the patient is reliable, a bandage contact lens may be placed to support healing.

Even though many corneal abrasions heal on their own, careful observation is necessary to catch any signs of infection, such as the development of an infiltrate or increased inflammation in the anterior chamber.

Corneal Laceration

A corneal laceration involves an injury that creates a cut through the layers of the cornea. These injuries can be partial or full thickness and require more careful evaluation because of the higher risk of complications—including infection or a potential breach of the inner eye structures.

• Exam Findings: An epithelial defect with a clear cut through the stromal layers, sometimes best visualized with a narrow slit lamp section. Advanced imaging like anterior segment OCT might be used to better assess the depth of the injury.
• Treatment: The first step is to check for any wound leaks using tests like the Seidel test. Many corneal lacerations need suturing to ensure that the eye is sealed properly. In addition, fortified antibiotic drops are often prescribed to lower the risk of infection, such as endophthalmitis.

Patients with corneal lacerations are usually advised to protect their eyes with a hard shield until they are evaluated by an eye specialist. Our eye doctors will closely monitor the healing process, ensuring that no further complications develop.

Traumatic Iritis

Traumatic iritis is inflammation of the iris that can occur after blunt trauma to the eye. This condition is typically characterized by pain, redness, and sensitivity to light (photophobia). When the iris is injured, white blood cells and other inflammatory mediators leak into the anterior chamber, causing noticeable inflammation.

• Exam Findings: There is often a visible “flare” or haziness due to the presence of white blood cells, and occasionally, a small layering of pus (hypopyon) may develop if the inflammation is severe.
• Treatment: Topical corticosteroids are commonly used to reduce the inflammation, along with cycloplegic agents to help relieve pain and minimize the risk of complications from iris damage.

Since the pupil may remain permanently dilated after significant iris injury, our eye doctors make sure to educate patients about this possibility during the treatment process.

Traumatic Hyphema

Hyphema refers to the pooling or collection of blood in the anterior chamber of the eye following trauma. These injuries are often associated with damage to the iris or ciliary body, and even a minor hyphema warrants careful monitoring.

• Exam Findings: The condition is recognized either by a microhyphema, which shows dispersion of red blood cells within the anterior chamber, or by a layered accumulation of blood that is visible upon examination.
• Treatment: Treatment includes the use of topical corticosteroids and cycloplegic agents. Patients are also advised to minimize physical activities and use eye patching during sleep to avoid further injury. Additionally, monitoring of intraocular pressure is crucial because hyphemas can lead to increased pressure, which sometimes requires intervention with medications that reduce aqueous production.

In cases where intraocular pressure does not stabilize or if signs of corneal staining are observed, further surgical evaluation may be necessary to prevent long-term damage such as traumatic glaucoma or angle recession.

Conjunctival Injuries

Conjunctival Abrasion

Conjunctival abrasions are injuries that affect only the thin epithelial layer covering the white part of the eye. These injuries often result from contact with a foreign object and, fortunately, tend to heal without long-term effects.

• Exam Findings: The defect is visible on the conjunctival surface, and staining with fluorescein clearly shows the area of the abrasion.
• Treatment: Prophylactic antibiotic drops or ointment are used to reduce the risk of infection. It is also important to carefully assess the eye for a deeper laceration if the injury seems more severe.

Conjunctival Laceration

When the injury extends deeper into the conjunctiva, a conjunctival laceration may occur. In these cases, the tissue may appear irregular or mobile, and underlying structures such as the sclera or Tenon’s capsule might be visible.

• Exam Findings: A full-thickness tear in the conjunctiva with possible exposure of deeper tissues. A Seidel test may be performed to assess whether there is a leak from the wound.
• Treatment: Prophylactic antibiotics are used universally, and in some cases, surgical repair is recommended—particularly when the laceration is longer than 1 cm or if there is a risk for abnormal scarring.

Conjunctival Foreign Bodies

Trauma can also lead to foreign bodies becoming embedded under the conjunctiva. This situation requires a careful examination to locate the foreign material and to determine if the surface of the eye has sustained recent injury and staining.

• Exam Findings: The presence of a foreign material may be obvious, with a small puncture or entry site visible upon staining.
• Treatment: Removal of the foreign body is performed after applying topical anesthetic, followed by a prescription for prophylactic antibiotics. It is critical to ensure that there is no scleral penetration during the removal process.

Orbital Fractures

Orbital fractures can occur when a forceful impact causes a break in the bones surrounding the eye. These injuries are most commonly seen in sports-related accidents, falls, or altercations. Patients often experience pain with eye movement, swelling around the eye, and sometimes double vision.

• Exam Findings: The eye may appear slightly protruded or sunken (proptosis or enophthalmos) depending on the nature of the fracture; patients might also report numbness along the cheek due to involvement of the maxillary nerve (V2).
• Treatment: A CT scan of the orbit is typically obtained to confirm the fracture and evaluate its extent. Surgical repair may be indicated if there is muscle entrapment, persistent double vision, or significant cosmetic concerns. In the meantime, our eye doctors advise patients to avoid activities that could worsen the injury and to protect the eye from further trauma.

Even though the risk of infection in cases of orbital fractures is relatively low, antibiotics may still be prescribed, especially if there is concurrent sinus involvement or if the patient is immunocompromised.

Ocular Chemical Burns

Chemical burns to the eye are medical emergencies that can result from exposure to acids or alkaline substances. Alkaline burns are of particular concern because they can rapidly penetrate the ocular tissues and cause extensive damage.

• Exam Findings: Patients typically present with severe pain, redness, and a diffuse loss of surface epithelial integrity which can be identified by the use of fluorescein staining. Additional signs may include corneal haze, symblepharon (adhesion of the eyelid), and elevated intraocular pressure due to ocular surface damage.
• Treatment: Immediate irrigation to normalize the pH is critical. The level of injury is then classified, and treatment is tailored accordingly. Mild injuries may be managed with preservative-free artificial tears, while more severe burns often require topical corticosteroids, antibiotics, and sometimes oral medications—such as vitamin C or doxycycline—to support healing and reduce inflammation.

Prompt intervention is essential in chemical burn cases to minimize the risk of permanent scarring and vision loss. Our eye doctors stress the importance of seeking immediate care following any chemical exposure to the eye.

Open Globe Injuries

An open globe injury involves a full-thickness disruption of the eye’s outer wall, which includes the cornea and sclera. These injuries are particularly serious because they expose the delicate internal structures of the eye to the external environment, greatly increasing the risk of infection and severe vision loss.

• Exam Findings: Signs of an open globe injury may include an irregular or misshapen globe, extrusion of intraocular contents (such as uveal tissue), and a positive Seidel test indicating leakage of fluid from the eye. Additionally, a teardrop-shaped pupil can be a key indicator of penetrating trauma.
• Treatment: Open globe injuries are considered vision-threatening and require urgent evaluation. The affected eye is protected with a hard shield, and the patient is kept NPO (nothing by mouth) as preparation for surgical repair begins. Immediate prophylactic antibiotics are administered to reduce the risk of infection, and a tetanus booster may be provided if necessary. Definitive surgical repair is typically scheduled within 24 hours to restore the integrity of the eye and prevent further damage.

Even though the management of open globe injuries is complex and may involve multiple surgeries, early intervention remains the cornerstone of preserving vision. Our eye doctors work closely with surgical teams to provide the necessary care and ensure the best possible outcomes.