Eye bruises and wounds: causes, symptoms, diagnosis, treatment

The consequences of blunt eye trauma range from disruption of the eyelid to damage to the orbit.

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Eyelid contusions ("black eyes")

Eyelid contusions (black eyes) are of more cosmetic than clinical significance; although in some cases, eyelid contusions may involve corneal damage, which is often overlooked. Uncomplicated contusions are treated with ice for the first 24-48 hours to reduce swelling, and hot compresses are subsequently used to resolve the hematoma.

Small lid tears that do not involve the lid margin or arch can be repaired with fine 6-0 or 7-0 nylon suture (or catgut in children). Lid margin repair should preferably be performed by an ophthalmic surgeon who can more accurately align the wound edges and maintain the contour of the eye. Large lid wounds that extend into the medial lower lid (possibly involving the lacrimal canal), through-and-through wounds that penetrate the periorbital tissue or lid arch should be repaired only by an ophthalmic surgeon.

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Trauma to the eyeball

Trauma may cause subconjunctival, anterior chamber, vitreous, retinal or retinal detachment hemorrhage; iris injury, cataract; lens dislocation; glaucoma and globe rupture. Examination may be difficult because of marked lid edema or lid injury. However, because some conditions may require immediate surgical intervention, the lids are gently separated, avoiding inward pressure, and the eye is examined as thoroughly as possible. At a minimum, examinations include visual acuity, pupillary response, range of ocular motion, anterior chamber depth or degree of hemorrhage, and the presence of a red reflex. Analgesics and anxiolytics may greatly facilitate the examination. Gentle and careful use of lid retractors and an ocular speculum will help separate the lids. First aid that can be given before the ophthalmologist arrives consists of dilating the pupil with 1 drop of 1% cyclopentolate or 1 drop of 2.5% phenylephrine, applying a protective shield, and taking measures to combat infection by local and systemic methods (as after removal of foreign bodies). In case of injury to the eyeball, local antibiotics are administered only in the form of drops, since penetration of ointment into the eye is undesirable. Due to the risk of fungal contamination of an open wound, glucocorticoids are contraindicated until the wound is surgically closed. Very rarely, after injury to the eyeball, the uninjured eye on the opposite side also becomes inflamed (sympathetic ophthalmia), and without treatment, vision loss up to blindness is possible. The pathogenetic mechanism is an autoimmune reaction; glucocorticoids in drops can prevent this reaction.

Depressed fractures

Depressed fractures result from blunt trauma directed through the most fragile portion of the orbit, usually the floor. Medial orbital wall and roof fractures may also occur. Symptoms include diplopia, enophthalmos, inferior displacement of the globe, numbness of the cheek and upper lip (due to injury to the infraorbital nerve), or subcutaneous emphysema. Epistaxis, eyelid edema, and ecchymosis may occur. The diagnosis is best made with CT. If diplopia and cosmetically unacceptable enophthalmos persist for 2 weeks, surgery is indicated.

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Posttraumatic iridocyclitis

Posttraumatic iridocyclitis (traumatic anterior uveitis, traumatic iris inflammation)

Posttraumatic iridocyclitis is an inflammatory reaction of the vascular and iris membranes of the eye, typically developing on the 3rd day after blunt eye trauma.

Symptoms of posttraumatic iridocyclitis include acute throbbing pain and redness of the eye, photophobia, and blurred vision. Diagnosis is based on history, symptoms, and slit-lamp examination, which typically reveals opalescence (due to increased protein content in the tissue fluid as a result of accumulation of inflammatory exudate) and leukocytes in the anterior chamber of the eye. Treatment consists of cycloplegic drugs (eg, 1 drop of 0.25% scopolamine, 1% cyclopentolate, or 5% homatropine methyl bromide, all drugs are prescribed 3 times daily). Topical glucocorticoids (eg, 1% prednisolone 4 to 8 times daily) are used to shorten the symptomatic period.