The structure of the face and eyes is well suited for protecting the eyes from injury. The eyeball is set into the orbit, a socket surrounded by a strong, bony ridge. The eyelids close quickly to form a barrier to foreign objects, and the eye can at times tolerate minor impact without damage.
Because of these protective features, many eye injuries may not affect the eyeball or cause significant damage. However, injuries should be evaluated because occasionally there is damage to the eye that needs treatment or impacts vision. In rare instances, vision may be completely lost or the eye must be removed.
Structures That Protect the Eye
Causes of Eye Injuries
Common causes of eye injury include accidents at home and in the workplace, exposure to toxic chemicals such as cleaning products (see Burns to the Eye), physical assault, accidents related to sports or other activities (including those from air guns, paint guns, or pellet guns), and motor vehicle accidents (including injuries caused by an air bag). People with eye injuries may also have other head or neck injuries. In addition, exposure to strong ultraviolet light, as from a welding arc or bright sunlight reflected off snow, can injure the cornea (see Superficial Punctate Keratitis).
An impact may cause eye injury and damage the
Structures at the front of the eye (the eyelid, conjunctiva, sclera, cornea, iris, and lens)
Structures at the back of the eye (retina and optic nerve)
Structures surrounding the eye (see Black Eye and Fractures of the Orbit)
Impact can cause bruising (contusion) and cuts (lacerations) to the tissues of the eye. Bleeding in the front of the eye (hyphema), back section of the eye (vitreous hemorrhage), tearing of the iris, displacement (dislocation) of the lens, and breaking (fracturing) the bones that surround the eye (orbital fractures) can result.
Evaluation of Eye Injuries
A person with an eye injury should be examined by a doctor. Glasses (if worn) should be brought so that the person’s vision can be assessed with their normal correction. This assessment can help the doctor know whether any abnormal vision is a new problem or an old one.
The eye examination may include a careful evaluation of the pupil (the black dot in the middle of the eye) and eye movements as well as a slit-lamp examination and ophthalmoscopy
If the injury is serious, particularly if the vision is affected, the doctor who first examines the person arranges for an ophthalmologist (a medical doctor who specializes in the evaluation and treatment—surgical and nonsurgical—of eye disorders) to evaluate and treat the person. Injured eyes may be very swollen and difficult to open, but doctors need to open the eyes to examine them and determine what injuries will need treatment. The eyes almost always can be opened gently, although instruments may be needed to do so. This should be done with care to avoid pressure on the eyeball in case there is any laceration to the eyeball itself.
Sometimes an imaging test (plain x-ray or computed tomography [CT]) is done as part of the evaluation of a person with an eye injury, particularly if the doctor suspects the presence of a foreign body in the eye or a fracture of the eye socket. Because plain x-rays do not adequately detect all foreign bodies, the doctor may use follow-up CT or magnetic resonance imaging (MRI) to confirm the presence of foreign bodies in the eye. However, MRI is never used as the first imaging test because its magnetic field could cause movement of any metallic foreign objects embedded in the eye.
Prevention of Eye Injuries
Use of eye guards, goggles, or special eyeglasses, such as those constructed of polycarbonate lenses in a wrap-around polyamide frame, is a simple precaution that greatly reduces the risk of eye injury. Specific protective eyewear is available for a variety of sports as well as for construction work.
