injuries poisoning
Overview of Eye Trauma
Introduction
Common causes of eye injury include domestic or industrial accidents (eg, during hammering or exposure to chemicals or cleaners), assault, sporting injuries (including air- or paint pellet-gun injuries), and motor vehicle crashes (including airbag injuries). Injury may be to the eyeball (globe), surrounding soft tissues (including muscles, nerves, and tendons), and/or bones of the orbit. General evaluation should include the following: Tests of visual acuity Range of extraocular motion Visual fields to confrontation Pupillary appearance and responses Location and depth of lid and conjunctival lacerations and of foreign bodies Depth of anterior chamber Presence of anterior chamber or vitreous hemorrhage, cataract, or red reflex Retinal examination Intraocular pressure determination Detailed examination of the sclera, anterior segment (cornea, conjunctiva, anterior chamber, ciliary body, iris), lens, and anterior vitreous is best done with a slit lamp (see Slit-lamp examination ). Although direct ophthalmoscopy can be used to examine the lens and posterior structures of the eye, indirect ophthalmoscopy, usually done by an ophthalmologist, provides a more detailed and binocular view of these structures. Indications for indirect ophthalmoscopy include clinical suspicion of vitreous abnormalities (eg, hemorrhage, foreign body) and retinal abnormalities; clinical suspicion may be based on symptoms, injury mechanism, absence of the red reflex, or retinal abnormalities visible with direct ophthalmoscopy. Because direct and indirect ophthalmoscopy are best done through a dilated pupil, about 15 to 30 minutes before this examination, mydriatics (such as one drop ofcyclopentolate1% and one drop ofphenylephrine2.5%, for adults) can be instilled when there is no contraindication to a dilated eye examination (eg, shallow anterior chamber, allergy, ruptured globe) and with caution in pregnancy. If an intraocular or orbital foreign body or an orbital fracture is suspected, CT is done. 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 injury. When eye drops are prescribed, each dose includes only one drop. (See also Retinal Detachment .) 