1. Blunt trauma to the eye can cause a variety of injuries depending on the force and location of impact, including direct damage to the eyeball at the point of impact, damage from compression waves transmitted through the eye's fluid contents, and indirect damage from impact with bony eye socket structures. 2. Specific injuries include abrasions, tears or detachments of the cornea, iris, retina, choroid or sclera, hyphema, cataracts, subluxation or dislocation of the lens, vitreous hemorrhages, glaucoma, commotio retinae, retinal tears and detachments, and macular holes. 3. More severe blunt trauma can cause

1. Uma Vijayaraghavan
Roll number: 159

2.  Injuries occuring during blunt trauma:
Coup or direct eg: corneal abrasions
Countercoup due to transmitted
pressure waves

3.  Blunt trauma may occur following:
 DIRECT BLOW to the eyeball by fist, ball or blunt
instruments like sticks or big stones.
 ACCIDENTAL BLUNT TRAUMA to eyeball which
occurs in roadside accidents,injuries by
agricultural and industrial machines,fall upon a
projecting object.

4.  Blunt trauma can produce damage by diff forces:
DIRECT IMPACT on globe: maximum damage at the
point where blow is received.
COMPRESSION WAVE FORCE: It is transmitted through
fluid contents in all directions and strikes angle of
anterior chamber, pushes iris diaphragm posteriorly
and also strikes the retina and choroid and injury
may sometimes be countercoup in nature.
REFLECTED COMPRESSION WAVE FORCE:after striking
the outer coats the compression waves are reflected
towards the posterior pole and may cause FOVEAL
damage.

5.  REBOUND COMPRESSION WAVE FORCE:
After striking the posterior wall of the globe,the
compression waves rebound back anteriorly.This
force damages the retina,choroid by forward pull
and lens-iris diaphragm by forward thrust from
back.
 INDIRECT FORCE: ocular damage is caused by
forces from the bony walls and elastic contents
of the orbit,when globe suddenly strikes these
structures.

7. 1. Mechanical tearing of tissues of eyeball
2. Damage to the tissue cells causing damage to
physiological activity
3. Vascular damage leading to ischaemia,oedema
and haemorrhages.
4. Trophic changes due to disturbances of nerve
supply.
5. Delayed complications of blunt trauma such as
secondary glaucoma,retinal detachment etc.

8.  CLOSED GLOBE INJURY
 GLOBE RUPTURE
 EXTRAOCULAR LESIONS

9. Contusional injuries may vary from a simple corneal
abrasion to an extensive intraocular damage.
CORNEA
o Simple abrasions:These are very painful and diagnosed
by fluorescein staining.These heal within 24hrs with
pad and bandage applied after instilling antibiotic
ointment.
o Recurrent corneal erosions(recurrent keractalgia)
Caused by fingernail trauma. Patient presents with
recurrent attacks of acute pain and lacrimation on
opening eye in the morning and is due to abnormally
loose attachment of epithelium to bowmans membrane.

10.  PARTIAL CORNEAL TEARS
 BLOOD STAINING OF CORNEA:from associated
hyphaema and raised iop.Cornea is reddish brown
or greenish in color and in later stages lead to
dislocation of lens into anterior chamber.It clears
very slowly from periphery towards the centre and
may take upto 2 yrs.
 DEEP CORNEAL OPACITY:It results from oedema of
corneal stroma or occasionally from folds in the
descemets membrane.

12.  Partial thickness scleral wounds occur alone
or with other lesions of closed globe type.

13.  TRAUMATIC HYPHAEMA or blood in anterior
chamber which occurs due to injury to iris or
anterior ciliary vessels.
 EXUDATES:these collect here following
traumatic uveitis

14.  TRAUMATIC MIOSIS:occurs initially due to spasm of
ciliary nerves or with spasm of accomodation.
 TRAUMATIC MYDRIASIS(iridoplegia):It is permanent
and is associated with traumatic cycloplegia.
 RUPTURE OF PUPILARY MARGIN
 RADIATING TEARS IN THE IRIS STROMA
 IRIDODIALYSIS: detachment of iris from its root at
ciliary body which results in ‘D’ shaped pupil and a
black biconvex area seen at the periphery.
 ANTIFLEXION OF IRIS: refers to rotation of
detached portion of iris in which its posterior
portion faces anteriorly.It occurs following
extensive iridodialysis.

15.  RETROFLEXION OF IRIS:occurs when whole of iris is
doubled back into ciliary region and becomes
invisible.
 TRAUMATIC ANIRIDIA:the completely torn iris sinks to
the bottom of anterior chamber in the form of a small
ball.
 ANGLE RECESSION:refers to tear between the
longitudinal and circular muscle fibres of ciliary
body,characterised by deepening of ant chamber and
widening of ciliary body on gonioscopy and leads to
glaucoma.
 INFLAMMATORY CHANGES:these include traumatic
iridocyclitis, post traumatic iris atrophy etc.
 TREATMENT-consist of atropine,antibiotics and
steroids.

16. iridodialysis:
Traumatic aniridia:

17.  VOSSIUS RING:It is a circular ring of brown pigment
seen on the anterior capsule.It occurs due to
striking of contracted pupillary margin against the
lens.
 CONCUSSION CATARACT:due to imbibition of
aqueous and due to direct mechanical effects of
the injury on lens fibres and may take any of the
following shapes-
1. Discrete subepithelial opacities
2. Early rosette cataract
3. Late rosette cataract
4. Traumatic zonular cataract
5. Diffuse concussion cataract
6. Early maturation of senile cataract

18.  Traumatic absorption of the lens:it can occur in
children leading to aphakia.
 Subluxation of lens:due to partial tear of zonules
and there is displacement of lens but is present in
the pupillary area-it can be lateral or vertical.
 Dislocation of lens:when rupture of zonules is
complete and can be intraocular or extraocular.
INTRAOCULARinto anterior chamber or posterior
vitreous
EXTRAOCULARsubconjunctival space or may fall
outside the eye

19. Vossius ring

20. Rosette cataract
Subluxation of lens

21.  Liquefaction and appearance of clouds of fine
pigmentary opacities.
 Detachment of the vitreous either anterior or
posterior.
 Vitreous haemorrhage.
 Vitreous herniation in anterior chamber may
occur with subluxation or dislocation of lens.

22.  Rupture of choroid: is concentric to optic disc and
situated temporal to it and can be single or
multiple.On fundus examination it looks like
whitish crescent with fine pigmentation at its
margins.Retinal vessels pass over it.
 Choroidal haemorrhage may occur under retina or
may even enter the vitreous if retina is torn.
 Choroidal detachment
 Traumatic choroiditis:seen on fundus examination
as patches of pigmentation and discoloration after
eye becomes silent.

23. Rupture of choroid

24.  COMMOTIO RETINAE(Berlin’s oedema):common
occurences following a blow on the eye.It
manifests as milky white cloudiness involving a
considerable area of posterior pole with a cherry-
red spot in the foveal region.It may disappear
after some days or may be followed by
pigmentary changes.
 RETINAL HAEMORRHAGES:eg:flame shaped and
preretinal D shaped haemorrhage may be
associated with traumatic retinopathy.
 RETINAL TEARS:these follow a contusion in eyes
suffering from myopia or senile degenerations.

25.  TRAUMATIC PROLIFERATIVE RETINOPATHY:occur
secondary to vitreous haemorrhage.
 RETINAL DETACHMENT: follows retinal tears or
vitreo-retinal tractional bands.
 CONCUSSION CHANGES AT MACULA: traumatic
macular oedema followed by pigmentary
degeneration.
Sometimes, a macular cyst is formed,which on
rupture is converted to a lamellar or full thickness
macular hole.

26. Commotio retinae-milkiness of posterior pole
Retinal haemorrhage
Macular hole

27.  TRAUMATIC GLAUCOMA
 TRAUMATIC HYPOTONY: it may follow damage to
the ciliary body and may result in phthisis bulbi.

28.  Myopia may follow ciliary spasm or rupture
of zonules or anterior shift of lens
 Hypermetropia and loss of accomodation may
result from damage to the ciliary body.

29.  It is a full-thicknesswound of eye-wall caused
by blunt object and can occur in 2 ways:
 DIRECT RUPTURE: at the site of injury.
 INDIRECT RUPTURE:occurs because of compression
force.The impact results in momentary increase in
IOP and inside out injury at the weakest part of the
eyewall,i.e in the vicinity of canal of schlemm
concentric to the limbus.The superonasal limbus is
the most common site.
TREATMENT:
A badly damaged globe should be enucleated.In less
severe cases it can be repaired under general
anaesthesia.

30.  CONJUNCTIVAL LESIONS: subconjunctival
haemorrhages are seen as bright red spot.
 EYELID LESION: Ecchymosis of eyelids.Because of
loose subcutaneous tissue,blood collects easily
into the lids and produces BLACK-EYE.Traumatic
ptosis may follow damage to leavtor muscle.
Laceration and avulsion of lids can occur.
 OPTIC NERVE INJURIES: associated with fracture of
base of skull.
 ORBITAL INJURY:there may occur fracture of
orbital walls. Orbital haemorrhage may produce
sudden proptosis. Orbital emphysema may occur
following ethmoidal sinus rupture.