Eye Trauma That Leads to Corneal Emergencies

• Eye trauma can be caused by irritants, recreational activities, disease, and even going to work. 
• Eye trauma can lead to loss of vision and even permanent blindness if medical treatment is not sought immediately.  
• Understanding ocular emergencies is of the utmost important to all nurses, as this leads to improved patient care and helps prevent vision damage.  

The human eye is an amazing and complex organ, yet vulnerable to many insults, from bruises and scratches to chemical burns, infections, blunt trauma, and penetrating injuries. For adults, yard work, cooking, and cleaning are potential threats. Sports and recreational activities expose children to risk of eye injuries. 

 Construction workers and those working with chemicals and harmful irritants have a higher risk of an eye trauma. To prevent permanent visual impairment and blindness, understanding ocular emergencies and their pathologies is of foremost priority for nurses and healthcare providers. 

Types of Eye Trauma & Emergencies

Corneal Abrasions

Any disruption of the corneal epithelium via foreign bodies or trauma can cause significant discomfort, photophobia, erythema, excessive lacrimation, and decreased visual acuity. For providers, fluorescein staining is the most useful clinical tool when assessing the injury.  

Fluorescein dye adheres to the abrasion and fluoresces under cobalt blue light. Discharge instructions include topical antibiotics and daily follow-up. For patients with simple corneal abrasions, tetanus prophylaxis is unnecessary unless the trauma to the eye is penetrating.

Central Retinal Artery Occlusion

Patients who experience sudden loss of eyesight in one eye need emergent screening for central retinal artery occlusion (CRAO). The abrupt blockage of the central artery can cause hypoperfusion of the retinal artery, progressing to cellular damage, and vision loss.

 To avoid irreversible retinal damage and blindness, treatment relies on the identification of embolus (cholesterol, calcium, and platelet-fibrin) or thrombus (atherosclerotic disease, collagen-vascular disease, inflammatory states, and hypercoagulable). Individuals with the comorbidities of high blood pressure, glaucoma, or diabetes are at a higher risk of arterial blockage. 

Risk factors include: 

• being male 
• hypertension 
• smoking 
• hyperlipidemia 
• diabetes 
• hypercoagulable state
  

Retinal Detachment

New floaters, flashes of light, dark shadow, or curtain in one eye or both eyes require emergent consideration for retinal detachment. A detached retina is a serious ocular condition and medical emergency that can lead to permanent vision loss. 

 If the retina detaches, it loses its oxygen and nutrients, leading to the death of the tissue. In the emergency setting, prompt diagnosis and treatment are essential to avoid morbidity. Diagnosis requires a dilated eye exam. 

Open Globe

When treating patients with eye trauma, evaluation of globe integrity is paramount for the potential vision-threatening emergency. In trauma, globe rupture describes open globe injuries, globe lacerations and globe perforation. Disruption of the globe can occur via penetration, perforation, laceration, or rupture due to blunt force trauma.  

Workplace injuries, assaults, gunshots, sporting injuries, stab wounds, blast wounds, and motor vehicle accidents are the common causes of globe trauma and in the elderly, ground-level falls.  

For diagnosis, clinical ophthalmologic examination comprises a slit lamp and fundoscopic exam. Recommendations include stat ophthalmologic consultation.  

Acute Angle Closure Glaucoma

Any sudden onset of severe unilateral eye pain requires consideration for increased intraocular pressure and outflow obstruction of aqueous humor. Patients who have associated headache, nausea, vomiting, blurred vision, multi-colored halos around bright lights require evaluation for acute angle-closure glaucoma.  

The ophthalmic emergency can lead to irreversible blindness. Acute angle closure causes a sudden increase in intraocular pressure (IOP) and may lead to permanent vision loss. Compromised structural anatomy of the anterior chamber and a shallower angle between the iris and the cornea predisposes patients to compromise. Clinical findings include a fixed midpoint pupil and a cloudy cornea upon exam.  

Endophthalmitis

For patients with colonization of an infectious agent, exudate, and inflammation within intraocular fluids of the inner eye, endophthalmitis needs consideration. The potential for blindness exists if left untreated. 

 Endophthalmitis classification includes two categories:  

• bacterial 
• and fungal 

Most endophthalmitis infections are secondary to gram-positive bacteria with 10% secondary to gram-negative bacteria, and 5% fungal. 

Orbital Cellulitis

Infections involving the muscles and fat of the orbital region have the potential for a serious sequela. The infection can include eyelid swelling with or without erythema. 

Cellulitis in the orbital region does not involve the globe and is more common in the pediatric population. Bacteria are the common causative organism, but orbital cellulitis can be secondary to fungal infections, or mycobacteria. 

Physical exam and clinical findings are the key in diagnosis. Ophthalmoplegia (pain with eye movement), and/or proptosis are the distinctive features. Imaging modalities such as Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) can confirm the diagnosis. 

Treatment includes broad-spectrum antibiotics to cover common organisms and supportive treatments such as NSAIDs and acetaminophen used alone or in combination to achieve effective pain control.

Infections of the orbit can progress into the adjacent anatomy and result in loss of vision, subperiosteal abscess, orbital abscess, and intracranial extension of the infection. For potential surgical cases, consider ophthalmic consultation. 

The Bottom Line

Medical treatment is available for eye trauma and is unique for each occurrence. Loss of vision and permanent blindness is possible if proper medical treatment is not administered to the patient. 

While the human eye is all seeing, everyday life is still a threat to it, so be prepared to treat any and all emergencies that befall it. 

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