Periocular trauma can affect not only the eye itself but also the surrounding eyelid tissue and bony skeleton. The severity of the trauma depends on the force and mechanism of injury; this can range from a minor bruising, to one requiring immediate medical attention and surgery.
Eye Socket Trauma
The eye socket is also referred to as the orbital cavity. The orbital walls consist of many different bones that join together. Blunt force trauma can often result in a variety of fractures of these bony walls. Orbital floor and medial wall fractures are the most common fractures of the eye socket. The floor of the orbit is made of thin bone which acts as a ‘crumple-zone’, absorbing the impact of the injury.
These types of fracture are also known as a blowout fracture which can leave a defect in the orbital floor.
The defect can trap muscles and connective tissues, which results in difficulty in eye movement and can cause double vision, particularly on upgaze. Loss of sensation around the cheek and a sunken appearance to the eye are also common.
Only extreme force can cause fractures of the orbital rim, as it is very thick. The nerves, muscles and connective tissues around the eye can also be affected.
These types of fracture are usually managed by an oculoplastic or maxillofacial surgeon who has specialist expertise in managing these fractures. More extensive fractures, particularly those involving the rim are generally managed by maxillofacial surgeons.
The eyelid is responsible for keeping the eye constantly moist, as it spreads the tear film evenly across the surface of the eye. When we sleep, the eyelid not only blocks out light but it also keeps the cornea from drying out. The lids also protect the eye from injury.
Bruising around the eyelids is very common after trauma. This can greatly impact eyelid function as the bruising can make the voluntary or involuntary opening and closing of the eyelids become painful and limited. Bruising alone, no matter how extreme, will usually resolve with time as the haematoma is cleared by the body.
The eyelids are soft structures, meaning that lacerations and avulsions are common after trauma. These lacerations can commonly involve the tear duct drainage system which will need to be identified and repaired along with the eyelid defect. Depending on the width and the depth of the laceration, surgical treatment will be usually be advised. If the laceration is simple, the repair can be made under local anaesthesia alone. I more complex lacerations and those involving the tear ducts, repair Is typically performed under general anaesthesia.
Trauma can also damage the eye itself. injury may be caused by mechanical trauma (blunt or penetrating) or by chemical agents. The common effects of eye trauma include:
-Traumatic Iritis: This type of injury can be caused after being poked in the eye or trauma to the eye from a blunt object. Iritis is the result of inflammation of the iris and ciliary body that surrounds the pupil. Traumatic iris usually requires treatment and
there is a risk of permanent decreased vision, even after medical treatment.
- Subconjunctival Hemorrhages: This occurs when the eye experiences trauma and the blood vessels break beneath the tissue covering the white of the eye. Although this condition is usually benign and causes no vision problems or discomfort, eye redness can also be a sign of other types of potentially serious eye conditions. A subconjunctival haemorrhage usually resolves after 1 -2 weeks.
- Chemical burn: Chemical exposures and burns can be caused by inoculation of substances other than clean water in your eye. Some substances (typically acids and alkalis) can cause serious injury. Depending on the substance exposed to the eye, the effects vary from minor irritation, serious eye damage and even blindness. After any chemical injury, immediate medical attention is advised. And the eye should be copiously irrigated as soon as is possible.
- Penetrating eye injury: This type of injury describes a breach in the tough coatings around the eye. Getting immediate medical help is essential. A full clinical assessment and possibly an ultrasound will be performed. It is likely that surgical repair will be required.