General Medical Information

Ocular Trauma

Jean Edwards Holt

When a patient sustains ocular trauma, the most important task is to differentiate a serious, potentially blinding problem and less serious problems. The care rendered by the first physician to examine a patient with ocular trauma frequently determines the visual outcome. A few minutes can make the difference between saving or losing sight. For these reasons, all patients with ocular symptoms should be treated according to an organized plan.

History and Examination

As in all specialties of medicine, a patient’s symptoms and history provide clues about what the examination may reveal. A tearing or scratchy sensation usually is trivial, but a chemical burn or penetrating injury can be visually devastating. The physician should always be cautious. A trivial or outwardly minor injury can be accompanied by a small perforation of the globe or penetration of a minute foreign body into the eye. The likelihood of perforation should always be borne in mind during examinations, regardless of how minor the injury may appear. After the most careful examination, if there is the slightest doubt about the presence of perforation, prompt referral to an ophthalmologist is recommended.

A detailed history, as would be appropriate in outpatient care or in evaluating a chronic problem, is not indicated or necessary in an emergency. Some issues are important, however. How did the trauma happen? For example, did something blow into the eye while the patient was walking outside, or was the patient grinding steel and struck by part of the machinery? When did the trauma happen? The chronology of events is extremely important. Also essential is the history of the eye. When a patient has a decrease in visual acuity, it is important to know whether that eye has had poor vision in the past or this is an acute change. Old trauma must be differentiated from the effects of a new injury.

After a history is obtained, careful inspection of the structures involved should be undertaken with documentation of visual acuity. This is important from a medicolegal point of view, and it is helpful in ascertaining the extent of the injury and monitoring of treatment. If a patient does not have his or her glasses for the examination if they were broken in the trauma, use of the pinhole test is important in evaluating vision to obtain the best possible acuity.