Ocular trauma is a significant contributor to preventable severe vision impairment in people of all ages, and it is the main cause of monocular blindness in American young adult men. Effective management depends on a thorough but secure clinical examination, supported where necessary by imaging. Any patient with mid-facial injuries should be evaluated with an eye on suspected ocular impairment and the potential need for early evaluation by an ophthalmologist [2]. Various traumas that are commonly seen are mentioned.

Conjunctival and Corneal Foreign Bodies

A foreign body is typically present on the cornea or under the upper lid if a patient report having "something in my eye" and provides a consistent history, even though it may not always be visible. Before starting treatment, a visual acuity test should be performed to determine the extent of the damage and to serve as a benchmark in the event of complications.

A diffuse rust ring is typically left by iron foreign substances. This requires excision, which is best carried out with a slit lamp and local anesthesia.

Within 24 hours, ocular epithelial cells will line the crater if there is no infection. The epithelium is damaged, but the cornea is incredibly prone to infection. A tiny amount of grey exudate and a white necrotic region surrounding the crater are signs of early infection [3].

Intraocular Foreign Body

An ophthalmologist must administer emergency care if there is an intraocular foreign body. Patients with a history of "something hitting the eye" especially those who have used tools for grinding or hammering metal should be examined for this possibility, especially if there is no corneal foreign body, no obvious corneal or scleral wound, or there is significant visual loss or media opacity. Such patients need to be referred right away and treated as though they have an open globe injury. The risk of intraocular infection is considerably increased by intraocular foreign substances [4].

Corneal Abrasion

A person who has had their cornea abraded complains of excruciating pain and photophobia. There is frequently a history of trauma to the eye, frequently caused by a contact lens, piece of paper, or fingernail. To rule out a foreign body, visual acuity is measured, and the cornea and conjunctiva are inspected with a light and loupe. Sterile fluorescein is injected into the conjunctival sac if an abrasion is suspected but cannot be detected. The region of the corneal abrasion will stain because fluorescein stains places that lack epithelium.

In order to prevent infection, treatment options include topical fluoroquinolone antibiotics for contact lens wearers or bacitracin-polymyxin ocular ointment or drops. Pain can be managed with a mydriatic (cyclopentolate 1%) and either topical or oral nonsteroidal anti-inflammatory drugs. Small abrasions probably won't benefit from an eye patch. Smokers recover corneal abrasions more slowly than non-smokers. After corneal abrasions, there may be repeated corneal erosion [5].

Contusions

A closed globe injury to the eye may result in ecchymosis ("black eye"), subconjunctival haemorrhage, corneal edoema, haemorrhage into the anterior chamber (hyphema), rupture of the iris (irido dialysis), paralysis of the pupillary sphincter, paralysis of the muscles of accommodation, cataract, dislocation of the lens, vitreous haemorrhage, retinal haemorrhage and e Some of these wounds are instantly noticeable, while others could take days or weeks to show.

The patient should be advised to rest until complete resolution has occurred. Frequent ophthalmologic assessment is essential. Aspirin and any drugs inhibiting coagulation increase the risk of secondary hemorrhage and are to be avoided. Sickle cell anemia or trait adversely affects outcome [6].

Lacerations

• Lid: The patient should be referred for professional care if the lid margin is torn because this could lead to persistent notching. The lower canaliculus is frequently severed by lacerations of the lower eyelid close to the inner can thus, necessitating canalicular intubation. Like any skin laceration, lid lacerations that do not involve the margin can be stitched.

• Conjunctiva: In lacerations of the conjunctiva, sutures are not necessary. To prevent infection, topical sulfonamide or other antibiotic is used until the laceration is healed.

• Cornea or Sclera: An emergency appointment with an ophthalmologist is required for patients with suspected corneal or scleral laceration or rupture (open globe damage). The least amount of manipulation is used since applying pressure could cause intraocular contents to extrude. The orbital bones above and below support a shield that covers the eye and is lightly wrapped. The patient needs to be told to stop squeezing their eyes tight and to keep still. To locate and identify any potential metallic intraocular foreign bodies, a radiograph or CT scan is taken [7].

Numerous eye injuries are possible as a result of blunt trauma. Due to vitreous hemorrhage, hyphemia, or damage to ther ocular or orbital structures, a quick assessment of the potential harm may be impossible or unwise. It is important to keep in mind that the angle or far retinal periphery may conceal potentially serious injuries. Even while one eye may show more overt evidence of injury in any given case of blunt trauma, a thorough examination of the other eye is always necessary since less severe impact may have caused catastrophic injuries that went unnoticed. Damage to the angle, lens, macula, and peripheral retina are the types of blunt trauma injuries that pose the most hazard to vision, so they must be observed and recorded. Early treatment of these lesions, especially retinal tears and elevated intraocular pressure, can help prevent potentially severe loss of vision [8].

1. Razeghinejad, R.L. et al. "Pathophysiology and management of glaucoma and ocular hypertension related to trauma." Survey of Ophthalmology, vol. 65, no. 5, 2020, pp. 530–547. Survey of Ophthalmology, www.surveyophthalmol.com/article/S0039625720300278/fulltext. Accessed 24 July 2022.

2. Loporchio, D. et al. "Intraocular foreign bodies: a review." Survey of Ophthalmology, vol. 61, no. 5, 2016, pp. 582–596. Survey of Ophthalmology, www.surveyophthalm ol.com/article/S0039625715300515/fulltext. Accessed 24 July 2022.

3. Fraenkel, A. et al. "Managing corneal foreign bodies in office-based general practice." Australian Journal of General Practice, vol. 46, 2017.

4. Ko, A.C., et al. "Eyelid and periorbital soft tissue trauma." Facial Plastic Surgery Clinics of North America, vol. 25, no. 4, 2017, pp. 605–616.

5. Wakai, A., et al. "Topical non‐steroidal anti‐inflammatory drugs for analgesia in traumatic corneal abrasions." The Cochrane Database of Systematic Reviews, 2017, doi: 10.1002 /14651858.CD009781.pub3. Accessed 24 July 2022.

6. Sahraravand, A., et al. "Ocular traumas in working age adults in finland – helsinki ocular trauma study." Acta Ophthalmologica, vol. 95, no. 3, 2017, pp. 288–294. Wiley Online Library, doi:10.1111/aos.13313. Accessed 24 July 2022.

7. Thylefors, B. "Epidemiological patterns of ocular trauma." Australian and New Zealand Journal of Ophthalmology, vol. 20, no. 2, 1992, pp. 95–98. Wiley Online Library, doi:10.1111/j.1442-9071.1992.tb00718.x. Accessed 24 July 2022.

8. Giovinazzo, V.J. "The ocular sequelae of blunt trauma." Advances in Ophthalmic Plastic and Reconstructive Surgery, vol. 6, 1987, pp. 107–114. PubMed, https://pubmed.ncbi. nlm.nih.gov/3331930/. Accessed 24 July 2022.