Eyelid Injuries
Definition
Eyelid injuries encompass a range of traumas to the protective skin and muscle layers
covering the eye, including lacerations (cuts that may be superficial or deep, potentially
involving the lid margin, tear drainage system, or levator muscle causing ptosis),
hematomas (collections of blood from ruptured vessels, often presenting as bruising or
a black eye), and avulsions (tearing away of tissue).
Etiology
Common causes include blunt trauma such as punches, falls, sports injuries, assaults,
or accidents (e.g., road traffic incidents), leading to hematomas and bruising; sharp
objects or penetrating injuries causing lacerations and avulsions. In children, these may
indicate non-accidental injury. Workplace hazards, like hammering or grinding, and
explosive debris can also contribute.
Treatment
Initial management involves assessing for underlying globe or orbital injuries and visual
acuity. For hematomas and bruising, apply cold packs or ice to reduce swelling and
pain; elevate the head. Superficial lacerations may be closed with sutures (e.g., 6-0
size) or adhesive strips if parallel to the lid margin. Complex lacerations involving the
margin, canaliculi, or levator require urgent specialist referral for surgical repair within
24 hours. Cover wounds with saline-soaked dressings, consider tetanus prophylaxis,
and prescribe antibiotics if infection risk is high. Avoid aspirin to minimize bleeding.
Follow-up includes wound checks and suture removal (5-14 days depending on
location).
Conjunctiva Injuries
Definition
Conjunctival injuries affect the thin mucous membrane covering the anterior sclera and
inner eyelids, including lacerations (tears or cuts, which may indicate deeper globe
penetration), subconjunctival hemorrhages (bleeding under the conjunctiva appearing
as bright red patches), congestion or edema (swelling and redness), and foreign body
embedment.
Etiology
Causes include blunt trauma (e.g., impacts from fists, balls, or blasts leading to
hemorrhages and tears), penetrating injuries (sharp objects, fragments, or high-velocity
debris), chemical exposures (acids, alkalis, gases like CS or pepper spray causing
burns, irritation, or infiltration), thermal burns (hot liquids or explosions), and UV
radiation (leading to keratitis). Spontaneous hemorrhages can occur from straining but
are often traumatic. In blasts, pressure waves or shrapnel are common culprits.
Treatment
For chemical burns, immediate copious irrigation with saline (up to 20L) until pH
neutralizes to 7.3-7.7, removing particles and contacts; use local anesthetics for
comfort. Subconjunctival hemorrhages typically resolve in 1-2 weeks without
intervention if isolated. Lacerations may heal spontaneously or require suturing; apply
topical antibiotics for infection prevention. For foreign bodies, gentle removal with
irrigation or cotton swabs. Severe cases need urgent ophthalmology referral,
cycloplegics, steroids, or anti-glaucoma meds. Avoid padding for certain gases; use
shields for suspected deeper injury.
Sclera Injuries
Definition
Scleral injuries involve the tough outer white layer of the eye, including partial or full-
thickness lacerations (tears with possible vitreous prolapse), ruptures (breaks from
increased pressure), and perforations (entrance/exit wounds). These often indicate
open globe injuries and may present with subconjunctival hemorrhage or uveal
prolapse.
Etiology
Primarily from blunt trauma (e.g., punches, sports equipment, falls, assaults causing
rupture at weak points like muscle insertions), penetrating objects (sharp metal, glass,
tools), high-velocity impacts (explosions, projectiles), or chemical/thermal burns.
Common in workplaces, sports, violence, or accidents; more vulnerable in elderly or
children.
Treatment
Suspected open globe: Apply rigid eye shield without pressure, avoid manipulation or
IOP measurement, provide analgesia/antiemetics, keep NPO, and urgently refer for
surgical repair and antibiotics to prevent endophthalmitis. Imaging (CT) for foreign
bodies. Postoperative care includes steroids and monitoring for complications like
glaucoma. For chemical involvement, irrigate immediately.
Iris Injuries
Definition
Iris injuries include traumatic iritis (inflammation), iridodialysis (detachment from ciliary
body causing D-shaped pupil), stromal tears, pupillary ruptures (leading to mydriasis or
miosis), and hyphaema (blood in anterior chamber). These can distort pupil shape and
function.
Etiology
Result from blunt trauma (blows, airbags, sports), penetrating injuries (sharp objects),
or chemical burns. Shearing forces from impacts or blasts cause tears and
detachments; associated with hyphaema from vessel rupture.
Treatment
For iritis, use topical cycloplegics and steroids to reduce inflammation and pain.
Hyphaema management: Bed rest with head elevation (30-45°), avoid anticoagulants,
topical mydriatics/steroids; treat elevated IOP with antihypertensives. Surgical washout
if needed. For detachments, surgical closure. Urgent referral for open globe suspicions
with shielding.
Ciliary Body Injuries
Definition
Injuries to the ciliary body, which produces aqueous humor and adjusts lens focus,
include detachments (cyclodialysis clefts causing hypotony), contusions (leading to
iritis or reduced accommodation), and angle recession (widening band, risking
glaucoma).
Etiology
Caused by blunt or penetrating trauma (impacts, blasts, sharp objects) disrupting
attachments; chemical burns penetrating to the anterior chamber. Common in
accidents, assaults, or sports.
Treatment
Topical atropine for clefts to promote spontaneous closure (6-8 weeks); laser or surgical
closure if persistent. For contusions, cycloplegics. Manage associated glaucoma with
antihypertensives; monitor lifelong. Treat underlying trauma with shielding and referral
for surgery if open globe.