The injured eye

Abstract

Eye injuries come at a high cost to society and are avoidable. Ocular blast injuries can be primary, from the blast wave itself; secondary, from fragments carried by the blast wind; tertiary; due to structural collapse or being thrown against a fixed object; or quaternary, from burns and indirect injuries. Ballistic eye protection significantly reduces the incidence of eye injuries and should be encouraged from an early stage in Military training. Management of an injured eye requires meticulous history taking, evaluation of vision that measures the acuity and if there is a relative pupillary defect as well as careful inspection of the eyes, under anaesthetic if necessary. A lateral canthotomy with cantholysis should be performed immediately if there is a sight-threatening retrobulbar haemorrhage. Systemic antibiotics should be prescribed if there is a suspected penetrating or perforating injury. A ruptured globe should be protected by an eye shield. Primary repair of ruptured globes should be performed in a timely fashion. Secondary procedures will often be required at a later date to achieve sight preservation. A poor initial visual acuity is not a guarantee of a poor final result. The final result can be predicted after approximately 3-4 weeks. Future research in eye injuries attempts to reduce scarring and neuronal damage as well as to promote photoreceptor rescue, using post-transcriptional inhibition of cell death pathways and vaccination to promote neural recovery. Where the sight has been lost sensory substitution of a picture from a spectacle mounted video camera to the touch receptors of the tongue can be used to achieve appreciation of the outside world.

Figure 1.

Traumatic hyphaema with inferior level of blood in anterior chamber.

Figure 2.

Birmingham eye trauma terminology system (BETTS).

Figure 3.

Traumatic lens dislocation.

Figure 4.

Choroidal rupture extending to the macula, with secondary epiretinal membrane formation (arrows) and retinal traction (arrowheads).

Figure 5.

Corneal perforation covered by bandage contact lens.

Figure 6.

Penetrating injury to eye from screw.

Figure 7.

US infantryman with ‘Sawfly’ combat eye protection with an embedded piece of shrapnel.

Figure 8.

Plain skull X-ray demonstrating orbital foreign body (rubber bullet).

Figure 9.

Computerized tomography scan of eye demonstrating IOFB in blast injury patient.

Figure 10.

An ultrasound biomicroscopic image showing metallic foreign body (arrow) and its shadowing effect (asterisk) in the ciliary body [54].

Figure 11.

Blinded war veteran demonstrates the BrainPort Vision Device.