What is damaged upon impact?
The impact energy is transmitted through the liquid media of the eye to all its shells. The iris can tear at the root, causing the pupil to lose its correct shape. The ligaments that hold the lens in place become torn, causing it to shift or become cloudy. The retina on the pole opposite to the blow gets bruised, swells and turns white, and on the periphery it can tear. Blood pours into the anterior chamber or into the vitreous body. A separate situation is a fracture of the thin lower wall of the orbit, in which the muscles are pinched and double vision appears.
- Hemorrhage into the anterior chamber of the eye
- Tears of the iris and changes in the shape of the pupil
- Displacement or clouding of the lens
- Retinal bruises and tears, hemorrhages
- Optic nerve damage
- Fracture of the walls of the orbit with muscle entrapment
First aid
The main rule is not to put pressure on the eye. Without pressing on the eyeball itself, you can apply cold to the area around the eye socket for 10–15 minutes to reduce swelling. The eyes should not be rubbed, washed or instilled with any drops without a doctor’s prescription. If there is a suspicion of a penetrating injury - eyelid wound, leakage, unusually soft eye - apply a light protective bandage to both eyes and immediately call 103 for help. You should not try to remove a foreign body stuck in the eye yourself.
- Coldness around the eye socket, no pressure on the eye
- Do not rub or rinse the eye
- Do not instill drops unless prescribed
- Do not remove stuck objects yourself
- If a penetrating wound is suspected, use a protective bandage and 103
- Examination by an ophthalmologist even in apparent well-being
Symptoms
Immediately after the impact, pain, lacrimation, photophobia and swelling of the eyelids appear, which can completely close the eye. Hemorrhage under the conjunctiva looks scary, but in itself is usually harmless and resolves in two to three weeks. Other signs are much more important. Decreased vision, fog, floating spots, flashes and loss of part of the field indicate damage to the retina or hemorrhage inside the eye. Double vision when looking up and numbness of the cheek are characteristic of a fracture of the lower wall of the orbit. Sharp pain with rainbow circles indicates an increase in intraocular pressure.
- Pain, swelling of the eyelids, photophobia
- Hemorrhage under the conjunctiva
- Decreased and blurred vision
- Floaters and flashes of light
- Double vision, limited eye movements
- Numbness of the skin of the cheek and upper lip
Diagnostics
The examination begins with checking the visual acuity of each eye - this is the main indicator of severity. The doctor then examines the anterior segment with a slit lamp, evaluates the condition of the cornea with staining, looks for blood in the anterior chamber, and checks the reaction of the pupil. Be sure to measure intraocular pressure and examine the fundus with a dilated pupil: this is the only way to see retinal tears and bruises. If the media are opaque, ultrasound is used. If an orbital fracture or foreign body is suspected, a computed tomography scan is performed.
- Checking visual acuity of both eyes
- Slit lamp examination and corneal staining
- Measuring intraocular pressure
- Fundus examination with pupil dilation
- Ultrasound of the eye in opaque media
- CT scan of the orbits for suspected fracture or foreign body
Treatment and consequences
Mild contusion requires rest, cold compresses for the first day and observation. In case of hemorrhage in the anterior chamber, semi-bed rest with the head of the bed elevated, limited exercise and drops according to the doctor’s regimen are prescribed to prevent re-bleeding and a rise in pressure. Retinal tears are closed with a laser; detachment and displacement of the lens are treated surgically; in case of a fracture of the orbit with muscle entrapment, surgery is required. Even with a successful outcome, monitoring is needed: months and years after the injury, the development of cataracts and secondary glaucoma is possible, so an examination once a year is mandatory.
- Rest, cold on the first day, limitation of exercise
- Drops as prescribed by a doctor, control of intraocular pressure
- Laser treatment of retinal tears
- Surgery for retinal detachment and lens displacement
- Surgery for a fracture of the orbital wall
- Annual examination by an ophthalmologist after an injury
