Most cuts (lacerations) around the eyes affect the eyelids rather than the eyeball.
(See also Overview of Eye Injuries.)
Eyelid Laceration
If the skin around the eye or on the eyelid has been cut, stitches may be needed. When possible, stitches near the edge of the eyelid should be placed by an ophthalmologist (a medical doctor who specializes in the evaluation and treatment—surgical and nonsurgical—of eye disorders). The stitches are carefully placed to ensure that no deformities develop that will affect the way the eyelids close and move over the cornea (at the front of the eye). An injury that causes the eyelid to droop goes through the entire thickness of the eyelid, or affects the tear ducts (ducts that drain tears off the eye) also should be repaired by an ophthalmologist. The tear ducts are in parts of both the lower and upper eyelids nearest the nose.
Severe injuries to the orbit (the area behind the eye that is surrounded by bone) can cause a sudden increase in pressure around and within the eye (called orbital compartment syndrome), either from internal bleeding or swelling around the eye. The doctor will check visual function and examine the eyeball in all eyelid injuries to protect against any potential loss of vision. If eyelid swelling is so great that it interferes with examination of the eyeball, an ophthalmologist should be consulted.
Sometimes the injury to the eyelid or skin around the eye is minor and there is only bruising (see Black Eye). The blood usually drains toward the bottom of the eyelid after 1 or 2 days, resulting in swelling and discoloration just below the lower eyelid. Black eyes themselves usually have no effect on vision, although other eye injuries that accompany them may be serious.
Eyeball Laceration
Of those lacerations that affect the eyeball, many are superficial. However, some cuts go through the white of the eye (sclera) or the transparent dome on the front surface of the eye (cornea), penetrating the eye’s interior. Such cuts are considered a rupture of the eyeball (globe). The globe also can be ruptured by a blunt force. Most people with a ruptured globe have decreased vision. The eye is often obviously distorted, and the pupil may be shaped like a teardrop. Sometimes fluid leaks out of the eye. Excessive bleeding under the conjunctiva (the thin mucous membrane that covers the cornea) is sometimes a symptom of a ruptured globe.
Eyeball lacerations can seriously damage the structures necessary for vision and make eyeball infection (endophthalmitis) more likely.
Diagnosis
An ophthalmologist's evaluation
Computed tomography (CT)
A laceration to the eyeball requires an immediate evaluation by an ophthalmologist. CT is done to confirm the diagnosis and to see if any foreign material is inside the eye or if there is other damage around the eye.
Treatment
Surgery
Surgical repair (with sutures) is often necessary for eyeball lacerations, except for some superficial injuries that affect only a small area of the thin mucous membrane that covers the cornea (conjunctiva). Even before surgery, antibiotics are given by vein (intravenously) to reduce the chance of infection within the eye. Ointments should be avoided.
Some superficial lacerations of the skin around the eye do not need surgery but can be repaired with closure strips or tissue adhesives.
If severe injury to the eye is suspected, including a ruptured globe, the eye should never be patched. A protective shield (either a commercial product or the bottom part of a paper cup) is taped over the eye to avoid placing unintentional pressure that could force the contents of the eye through the laceration. If any foreign body protrudes from the eyeball or around the eyeball, it should be left in place until an ophthalmologist can see the person.
Pain medications are given by vein or, if surgical repair is not needed, by mouth. If necessary, vomiting can be controlled with medications that relieve nausea. A tetanus vaccine is given as soon as possible.
Prognosis
Even after all possible medical and surgical treatment, a serious eyeball laceration may result in partial or total loss of vision. Very rarely, after a severe eyeball laceration (or eye surgery), the uninjured eye becomes inflamed (sympathetic ophthalmia), which may result in partial loss of vision or even blindness if left untreated. Topical and systemic medications can effectively treat this reaction. Doctors may remove an irreversibly damaged eye with no vision to prevent sympathetic ophthalmia and to improve the external appearance.
