injuries poisoning
Eye Contusions and Lacerations
Globe
Trauma may cause the following: Conjunctival, anterior chamber, and vitreous hemorrhage Retinal hemorrhage, edema, or Retinal Detachment None Laceration of the iris Cataract None Dislocated lens Overview of Glaucoma None Globe rupture (laceration) Evaluation can be difficult when massive lid edema or laceration is present. Even so, unless the need for immediate eye surgery is obvious (necessitating evaluation by an ophthalmologist as soon as possible), the lid is opened, taking care not to exert pressure on the globe, and as complete an examination as possible is conducted. At a minimum, the following are noted: Assessing Visual Acuity None Pupil shape and pupillary responses Extraocular movements Anterior chamber depth or hemorrhage Presence of red reflex In descending order of acuity, vision is assessed as Reading a Snellen chart Counting fingers while noting distance (eg, counting fingers at about 1 inch [3 cm]) Detecting hand motion Perceiving light Lacking light perception An analgesic or, after obtaining any surgical consent, an anxiolytic may be given to facilitate examination. Gentle and careful use of eyelid retractors or an eyelid speculum makes it possible to open the lids. If a commercial instrument is not available, the eyelids can be separated with makeshift retractors fashioned by opening a paperclip to an S shape, then bending the U-shaped ends to 180°. Globe laceration should be suspected with any of the following: A corneal or scleral laceration is visible. Aqueous humor is leaking (positive Seidel sign). The anterior chamber is very shallow (eg, making the cornea appear to have folds) or very deep (due to rupture posterior to the lens). The pupil is irregular (possibly indicating herniation of the iris). The red reflex is absent (possibly indicating vitreous hemorrhage, or retinal injury). If globe laceration is suspected, measures that can be taken before an ophthalmologist is available consist of Treatment and combating possible infection with systemic antimicrobials as for Very rarely, after laceration of the globe, the uninjured, contralateral eye becomes inflamed ( Sympathetic Ophthalmia ) and may lose vision to the point of blindness unless treated. The mechanism is an autoimmune reaction; corticosteroid drops can prevent the process and may be prescribed by an ophthalmologist. 