When an eye has been injured we inquire into the attendant circumstances with a view to learn the nature of the object with which the damage was inflicted, and the direction from which it struck the eye, as in many cases this information is of material assistance in explaining the nature of the lesions we may find. If the object was large and blunt it produced a contusion, perhaps associated with lacerations, and the lids are swollen and ecchymotic in a fresh case. If it was sharp there may or may not be an incised wound of the lids, as well as of the eye itself. If it was a small flying body the lids may be closed spasmodically, but they seldom show any external evidence of a wound, whether the foreign body is or is not within the eye.
<Callout type="important" title="Critical Assessment">It's crucial to separate the eyelids carefully without applying pressure on the eye to check for corneal or scleral rupture.</Callout>
CONTUSIONS The ecchymotic lids may be so oedematous as to be completely closed, or the patient may be able to open his eyes more or less, and the swelling may not be proportionate to the harm done. If he can see with the eye we hope to find little or no damage, but a fair amount of vision does not exclude a serious injury, while an immediate loss of sight does not necessarily imply that the eye is lost.
<Callout type="risk" title="Risk of Secondary Glaucoma">A hyphema may cause secondary glaucoma if it blocks the aqueous outlet.</Callout>
When the anterior chamber is full of blood and the absorption is slow, the cornea may become stained by the imbibition of the coloring matter. Instead of a hyphema we may find a gelatinous exudate in the anterior chamber which renders the aqueous cloudy. This indicates a paralysis of the vessels of the iris and ciliary body and may give rise to secondary glaucoma.
<Callout type="tip" title="Quick Assessment">If the pupil is very small, it could indicate trauma-induced spasm or saturation of the iris.</Callout>
The lens may be luxated or subluxated in any direction, and may or may not be opaque. It may be placed obliquely, with one edge directed more or less forward.
<Callout type="warning" title="Immediate Attention Required">If pain radiates through the side of the head, a ciliary injection is present, and tension increases steadily, suspect lens luxation into the anterior chamber.</Callout>
In other cases we see flaky or striated masses of blood that move about in the vitreous, or a large red disk, either round or with a straight horizontal upper edge, between the retina and the vitreous. The presence of the latter is not necessarily an indication that the eye has been struck, as sometimes it is caused by an injury to the head, or by some other trouble which creates a disturbance in the intracranial circulation and results in engorgement.
Traumatic cedema of the retina may be associated with a small pupil which is not affected by atropine as much as usual. An hour or two after the accident we can see whitish spots scattered about in the fundus, which increase in size and coalesce, until at the end of twenty-four hours a large part of the retina is opaque and grayish, or grayish white, inclining sometimes to yellowish.
<Callout type="beginner" title="Understanding Symptoms">A traumatic cedema can be differentiated from retinal detachment by observing the normality of vessels in the former.</Callout>
When the media are sufficiently clear to permit an ophthalmoscopic examination we may happen to see a grayish red, hemispherical, smooth protuberance into the vitreous, over which run dark, tortuous vessels. If the protrusion is very pronounced we know that the retina has been detached by a hemorrhage, but if it is flat the detachment may be either of the retina or of the choroid.
Contusions with Rupture of the Capsule of the Eye Less often when we lift the upper lid we see a more or less jagged tear in the cornea, sclera, or both, usually with some of the tissues that belong within the eye caught between its edges. Our first duty in such a case is to clear away any detritus in the conjunctival sac, and to trim off all of the prolapsed tissues, not only as the first step in treatment, but also to enable us to observe more accurately the damage that has been done, and so gain a better opportunity to judge of the prognosis and of the best treatment to employ. This is done in the same way as when we are dealing with a penetrating wound.
Key Takeaways
- Identify the nature and direction of injury to understand potential eye damage.
- Separate eyelids carefully to assess corneal or scleral rupture without applying pressure.
- Hyphema can cause secondary glaucoma if it blocks aqueous outflow.
- A dilated pupil may indicate lens luxation or sphincter tear.
Practical Tips
- Quickly check for vision and eye movement to assess initial damage.
- Use atropine cautiously as a small, unresponsive pupil might be due to trauma-induced spasm.
- Monitor the patient for signs of secondary glaucoma after hyphema.
Warnings & Risks
- Pain radiating through the side of the head and increasing tension may indicate lens luxation into the anterior chamber.
- A large hemorrhage in the vitreous can lead to serious retinal, choroid, or ciliary body injuries.
- Traumatic cedema can be mistaken for retinal detachment if not properly observed.
Modern Application
While modern medical practices have advanced significantly since 1917, understanding historical diagnostic techniques remains crucial. This chapter provides foundational knowledge on assessing eye injuries and recognizing critical symptoms like hyphema and secondary glaucoma. Modern readers can apply these principles to quickly identify severe conditions in emergency situations until professional help is available.
Frequently Asked Questions
Q: What are the key signs of a serious eye injury?
Key signs include swelling, ecchymosis (bruising), inability to open eyes due to swelling, and significant vision loss. However, even with fair vision, there can still be serious internal injuries.
Q: How do you differentiate between hyphema and gelatinous exudate?
Hyphema is a collection of blood in the anterior chamber, while a gelatinous exudate indicates paralysis of the iris and ciliary body vessels. Both can cause secondary glaucoma if not managed properly.
Q: What does a dilated pupil indicate after an eye injury?
A dilated pupil may suggest lens luxation or sphincter tear, but it could also be due to trauma-induced spasm of the iris. Proper examination is necessary to determine the cause.