Eye Injuries Can Have Long-term Complications

Eye injuries can immediately turn your world upside down. As experts in representing eye injury victims in the Seattle area, Premier Law Group understands the fears when facing an uncertain future due to vision impairment or loss. To help you and your loved ones make informed decisions after experiencing an eye injury, we want to provide you with some basic information about eye trauma.

Statistics

In a study completed between 2007 and 2010, eye treatment was necessary in 77.2 per 100,000 patients in the community hospitals and 208.9 per 100,000 patients in the trauma centers. 66.7% of patients with fall injuries and open globe (break of sclera and cornea as pictured below) diagnoses resulted in legal blindness (Cheung, et al., 2013).

What Tests and Procedures Can I Expect?

Below is information for expected assessments, tests, and results that you may receive for the many types of injuries that can happen related to the eye. As you can see from the image below, there are many injuries that can involve the eye (small member of the body with many parts). This information will not be all-inclusive, but informative for common injuries in trauma related to the eye.

Blunt or penetrating trauma can be caused by a car accident, physical violence/assault, sports injury, falls, or any object that may hit the eye. This can cause problems to the exterior part of the eye, the inside structures, or the back of the eye (all potentially affecting one’s sight).

Types of Procedures

• Numbing eye drops such as tetracaine or proparacaine for tolerating assessment or applicable procedures.
• Radiology scans: ultrasound, CT, MRI
• Focused examination with any of the following:

– Slit lamp: a microscope that is placed very close to the eye, and the examiner is able to see a 3D image of the person’s eye by “slits” (beams) of light that shine at different angles to visualize anatomy and diagnose injuries.
– Fluorescein strip: a small paper that is moistened and touched to the lower inner eyelid for color change in eye to more easily view a corneal abrasion (scratch on the cornea).
– Woods lamp: a much smaller hand-held light device that shines an ultraviolet light that magnifies the eye two to three times. For more precise visualization, a slit lamp is used.
– Tono pen: a small hand-held device that checks the pressure inside the eye. The round tip is touched to the eyeball, and a pressure reading is given to the user. This will tell the user if there is elevated pressure and potential damage inside the eye which may need an intervention to relieve the pressure.
– Visual acuity: charts to distinguish characters at different distances (see below).
– Shield/eye patch to protect the eye.
– Multiple vision assessments related to eye movement and vision changes (i.e., double vision, floaters, black spots, blurriness, light sensitivity, pupil reactions to light, eyelid movements).

(Snellen Chart- normal visual acuity 20/20)

Types of Eye Injuries & Treatment

Chemical Eye Injury – Risk for Vision Loss

• Flushing the exposed eye
– After an exposure, it is a priority to flush the eye. Risk for permanent injury depends on the type of chemical and the amount of time that the eye was exposed to the chemical. It is important that the eye is flushed as soon as possible and long enough to achieve the normal pH level for the eye.

• Assessment
– pH of the eye is tested after initial irrigation, after 30 minutes of irrigation, and then every 15-30 minutes until normal range has been attained. Normal pH of the eye is 6.5-7.5. A small pH paper strip is touched the inner lower eyelid and corresponding color changes indicate pH level.
– Device called a Morgan lens may be used for extended irrigation of the eye (see picture below). It looks like a contact lens that is attached to a bag of fluid. The bag (often containing saline) is held above to allow the liquid to drip over the eye for continuous flushing of debris and contamination.

Increased Pressure Inside the Eye

• Can be caused by bleeding from a blood vessel inside the eye.
• Assessment

– Be on alert for visual changes, tight/hard eyelids, bleeding around conjunctiva (lining around eye and eyelid), and pain.

• Management

– Head should be elevated allowing gravity to help with decreasing pressure.
– Medication may be given to prevent symptoms such as vomiting, constipation, and coughing, that increase the pressure.
– A canthotomy may be required if the pressure is too high, which can be completed by a surgeon, ER doctor, or ophthalmologist. This procedure requires cutting the eyelid to make space for the expanding eye. Higher pressure within the eye can press on nerves and blood vessels, decreasing oxygenation and resulting in vision loss.

Cut or Penetrating Object to the Eye

• Assessment

– Manual irrigation may be necessary (no Morgan lens). Depending on location, foreign bodies may not initially be removed. No extra pressure should be placed on the eye, including assessment with tono pen, nor should medication be given directly in eye. If possible, eye shield may be placed to protect eye for ophthalmologist intervention.
– Hyphema is bleeding that can be seen on visual inspection. The bleeding is from red blood cells that are gathered on the front of the eye. A slit lamp is used to visualize the depth that the blood cells are gathered and the severity of the bleeding.
Damage/injury to Retina (back of eye)

• Assessment

– Can be seen after head trauma (i.e., fall and abuse cases). This may result in bleeding in the inner part of eye (vitreous body as seen in previous diagram). The bleeding may be noted on exam, when the normal reddish/orange reflection is absent while shining a light with ophthalmoscope.
– Vision loss is described as partial, complete, flashers, floaters, or curtain pulled over eyes.
– Some options of treatment are laser therapy and cryotherapy (cold). If there is full detachment of the retina, surgical repair is necessary.

• Purtscher’s retinopathy

– A rare injury to the retina that is not directly from trauma to the eye.
– Tiny emboli can come from fat from a bone fracture (such as the humerus or femur); air emboli from blunt force to chest; or clots from abnormal clotting related to trauma. In this situation, the tiny blood vessels that supply blood to the retina are blocked.
– “Purtscher flecken” appear as cotton wool spots (the tiny clots blocking the blood flow). This can be seen and diagnosed with angiography.
– There can be long term vision changes and loss from this injury. There is no definite treatment. Some people are given steroids and anti-inflammatory drugs with little difference in result from only observation. Some may heal without treatment.

Optic nerve injury (back of eye)

• Can be caused from direct force such as foreign body puncture or blunt force to head or eye that crushes the nerve (such has force to the temple/brow area). Treatment is decided by cause of injury. People with this injury may have decreased vision and/or color vision.

Other Eye Injuries

• More common but less severe injuries to the eye include corneal abrasions (scratches), foreign bodies, eyelid injury, conjunctival injury (damage to the lining around the eye/eyelid).

What Kind of Help Can I Get?

It is important that eye injuries are treated as quickly as possible. After treatment, there can be lasting effects on normal life that are forever changed. If you or a loved one have been injured and experience loss of work, inability to transport self or others, or change in enjoyment of life related to sight, you may be entitled to compensation that can ease this transition.
In many cases, eye trauma is caused by accidents, often due to the negligence of someone other than the victim. If this applies to your injury, please contact our eye injury attorneys at Premier Law Group. Learn more about your rights as a victim and whether a legal case is the right option for you. Together, we can help you seek just compensation, so you can focus on your recovery and return to a fulfilling life. Call us at 206.285.1743 for a free evaluation.

References:
Cheung, C. A., Rogers-Martel, M., Golas, L., Chepurny, A., Martel, J. B., & Martel, J. R. (2013). Hospital-based ocular emergencies: epidemiology, treatment, and visual outcomes. PubMed. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/24418441

Gardiner, M. F. (2020, January 14). Overview of eye injuries in the emergency department. Retrieved March 31, 2020, from https://www.uptodate.com/contents/overview-of-eye-injuries-in-the-emergency-department?search=ocular emergencies&source=search_result&selectedTitle=1~30&usage_type=default&display_rank=1#H1905285

Gardiner, M. F. (2020, January 14). Approach to eye injuries in the emergency department. Retrieved March 31, 2020, from https://www.uptodate.com/contents/approach-to-eye-injuries-in-the-emergency-department?search=ocular emergencies&source=search_result&selectedTitle=2~30&usage_type=default&display_rank=2#H1902425

Hooker, E. A., Faulkner, W. J., Kelly, L. D., & Whitford, R. C. (2019). Prospective study of the sensitivity of the Wood’s lamp for common eye abnormalities. PubMed. Retrieved from https://www.uptodate.com/contents/slit-lamp-examination/abstract/4

Kaushik, S., & Bird, S. (2020, January 28). Topical chemical burns: Initial assessment and management. Retrieved March 31, 2020, from https://www.uptodate.com/contents/topical-chemical-burns-initial-assessment-and-management?sectionName=Eye exposure&search=ocular emergencies&topicRef=104455&anchor=H9&source=see_link#H7

Knoop, K. J. (2019, March 20). Slit lamp examination. Retrieved March 31, 2020, from https://www.uptodate.com/contents/slit-lamp-examination?search=ocular emergencies&topicRef=13903&source=see_link

Story, C. M. (2016, February 4). Tonometry. Retrieved March 31, 2020, from https://www.healthline.com/health/tonometry

Tripathy, K., & Patel, B. C. (2019, November 13). Purtscher Retinopathy. Retrieved March 31, 2020, from https://www.ncbi.nlm.nih.gov/books/NBK542167/