Eye injuries and contusions
Eye injuries are common, whether from a collision, while playing sports, or even at home. Their severity varies greatly, depending on the mechanism of the impact and the energy involved. While many are minor, they are nonetheless a legitimate cause for concern. The most serious injuries require immediate emergency care. Here's what you need to know about the mechanisms and consequences. Please note that an article, accessible here, is specifically dedicated to eye injuries caused by projectiles, burns, and foreign bodies .
General information and mechanisms
Eye injuries are very common pathologies whose severity varies greatly and will depend on the area affected, the mechanism involved, and the intensity of the impact.
While prevention, both professional and domestic, allows for a reduction of risks, some activities remain "accident-prone".
The main mechanisms are of two types: contusion by a blunt object or wound, in which case it is generally caused by a sharp object.
Eye contusion injuries
Contusions are injuries caused by an impact, without tissue rupture. The eyeball remains closed and the structures of the eye are affected by the shock wave.
Blunt objects – Bruises are caused by blunt objects, which cause injury without cutting. The injury is due to the rapid deformation of the eyeball, which is crushed under the pressure of the impact. The smaller the blunt object involved, and the greater the energy of the blow, the greater the danger to the eyes. Among the most frequently involved objects are balls (tennis balls, soccer balls, badminton shuttlecocks), body parts (elbow strikes, punches, headbutts, etc.), corks, and a variety of other objects that can strike the eye socket.
Symptoms – Depending on the severity of the impact, the injured person may or may not experience pain, decreased vision, redness (subconjunctival hemorrhage), and numerous injuries, the most feared of which (particularly in boxing) is retinal detachment . Sometimes, symptoms do not appear immediately. For example, retinal detachment, which manifests as blurred vision and decreased vision, as well as post-traumatic inflammation, which manifests as redness of the eye, sensitivity to light (photophobia), and pain, symptoms appear after a few days. This is why a consultation, during which a fundus examination will be performed, is essential.
Eye injuries
Eye injuries are of two types: penetrating (deep) and non-penetrating (superficial)
Non-penetrating wounds – These can be caused by a foreign body (specific article available here) or by friction from a sharp object that did not cut deeply enough to completely perforate the globe. In both cases, an examination is necessary. In the case of a foreign body, it will allow for its removal. In the case of a non-penetrating wound (sometimes with very few symptoms), it will allow for an assessment of its severity and the administration of appropriate treatment.
Penetrating wounds – Penetrating eye wounds are the most serious. In rare cases, they can be caused by extremely violent contusions, but more often they result from a sharp object (nail, blade, sharp projectile, etc.). Pain is not always present. Suturing must be performed as quickly as possible, as an emergency. Hospitalization is almost always necessary for intravenous antibiotic administration. The prognosis is usually very poor.
Risky situations
Sports accidents and the practice of boxing
Eye injuries are common among athletes, especially children and young adults.
Some sports are riskier than others, and not always violent sports. Combat sports (boxing, martial arts), for obvious reasons, are at the forefront of this risk.
Some athletes are sadly famous for their eyes, such as boxer Sugar Ray Leonard who temporarily interrupted his career due to a detached retina.
Football, particularly in its 5-a-side form (urban foot), is also a major source of severe eye injuries due to the proximity of players when a ball is struck and the lack of time to protect oneself.
Ball sports of all kinds can also cause injuries, including rugby and any situation involving eye trauma.
The most frequent serious complications are: retinal detachment , vitreous detachment or traumatic cataracts .
Post-traumatic inflammation or hypertonia, benign complications, are also frequently observed (red and painful eye).
An examination of the fundus of the eye is essential and should be systematic after any of these incidents because the best treatment for retinal detachment is prevention!
Various accidents (road traffic accidents, domestic accidents, etc.):
Road traffic accidents (especially broken windshields), domestic accidents (knives, scissors), DIY projects or assaults can lead to direct injuries to the eyeball.
Young children are particularly at risk of domestic accidents. Accidental spills of liquids are also frequent (a topic covered in an article available here) .
The famous champagne (or cider) cork:
The projection of a cork when opening a bottle is not a myth.
The proximity, power and size of cork make it an enemy of the eyes.
The consequences are not always severe, but genuine retinal detachments and severe trauma are regularly observed on December 31st…
The projectiles
War games and fake weapons such as paintball and BB guns, but also flashballs, as well as projectiles from real or fake weapons, can have very serious consequences and damage the eyes of adults and children.
Complications, management and treatment
Contusion injuries
Contusions are the most common type of injury. Regardless of the cause, the possible consequences are as follows:
Subconjunctival hemorrhage – Frequently observed. In isolation, it is perfectly benign but may conceal an underlying injury. If there is any doubt, the ophthalmologist will recommend an examination in the operating room.
Eye inflammation – The area around the eyeball becomes red and painful. It sometimes appears slightly later (a few days after the injury). It is treated with anti-inflammatory eye drops.
Ocular hypertension – Frequently observed, often transient. It is treated with hypotensive eye drops and sometimes with tablets. If left untreated, it can lead to corneal hemorrhage.
Post-traumatic cataracts – These can occur after a violent impact. They manifest as a decrease in vision and require cataract surgery.
Retinal detachment – This is the most feared complication, as it is often asymptomatic in the early stages. Therefore, any eye injury should be examined through a fundus examination. In the case of a tear, laser treatment will be recommended. If a detachment is confirmed, surgery must be performed immediately. This constitutes a surgical ophthalmological emergency.
Rupture of the globe and avulsion of the optic nerve – Some very violent traumas can lead to rare complications such as the severing of the optic nerve (avulsion) or the rupture of the globe into fragments.
Orbital fracture – Punches can be associated with a fracture of the orbital floor, which is why orbital imaging (CT scan or X-ray) will sometimes be prescribed.
Non-transfixing wounds
For non-transfixing globe wounds, directed (spontaneous) healing treatment will be prescribed to allow healing and prevent infection.
The prognosis will depend on the area affected. A small conjunctival tear will have no consequences, whereas a corneal tear, even a non-penetrating one, will sometimes leave a significant scar (corneal opacity) that can lead to a significant decrease in visual acuity.
Penetrating wounds
Transfixing wounds, with few exceptions (such as self-sealing wounds), always require emergency surgery.
Their prognosis, except in rare cases, is often very grim, the issue sometimes being the preservation of aesthetics rather than that of visual function.
Actions to take and prevention
Emergency procedures to follow
In an emergency, the only thing to do is to protect the injured eye with a compress or clean cloth, avoid touching it, and consult an ophthalmological emergency facility without delay.
If possible, bring someone with you.
Should you consult a doctor even if no particular symptoms appear?
In the event of a blow to the eye, even without symptoms, it is necessary to consult a doctor to check for the absence of asymptomatic lesions, particularly retinal lesions.
Prevention: Protect your eyes!
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Prevention remains the best remedy. Protect your eyes and those of your children.
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When doing DIY projects, wear your safety glasses.
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Keep a close eye on young children and the objects they play with to prevent accidents.