The document discusses blunt trauma to the eye. It describes the different types of ocular injuries that can result from blunt trauma, including closed globe injuries and globe rupture. Closed globe injuries involve damage to structures like the cornea, iris, lens, vitreous humor, and retina. Globe rupture is a full-thickness wound of the eyeball that can occur directly at the site of impact or indirectly from a compression force inside the eye. The document provides details on the mechanisms of various blunt eye injuries and their clinical presentations.

1. Blunt trauma
of the eye
Presented By:
Salwa Ahmed Elkelany
5th year – Ophthalmology department
Faculty of medicine –Suez Canal university
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2. Types of Ocular injuries :
1. Blunt
2. Perforating
3. Foreign Body
4. Radiation
5. Chemical
6. Thermal
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4. Injuries occur during blunt
trauma
Coup or direct
Eg: corneal
abrasions
Antero-posterior
compression &
Horizontal
expansion
Eg: rupture globe
Countercoup due to
transmitted pressure
waves to the post.
Pole
Eg : commotio retina
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5. Modes of injury
- Blunt trauma may occur by :
Direct blow to the eye ball by fist, ball or blunt instruments like sticks, and
big stones.
- Accidental blunt trauma to eye ball
may also occur in accidents, injuries by instruments , fall upon the projecting
blunt objects.
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6. Mechanism of blunt trauma to Eye Ball
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7. Traumatic lesions of blunt trauma
1. CLOSED GLOBE INJURY
2. GLOBE RUPTURE
3. EXTRAOCULAR LESIONS
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8. 1- Closed globe injury
Contusion injuries may vary from a simple corneal abrasion to an extensive
intraocular damage.
CORNEA
o Simple abrasions: Corneal epithelium Damage
(Ulcer)
These are very painful and diagnosed by
fluorescein staining.
These heal within 24hrs with pad and
bandage applied after instilling antibiotic ointment.
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9. ○ 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 Bowman’s membrane.
○ Partial corneal tears ( lamellar corneal lacerations )
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10.  BLOOD STAINING OF CORNEA:
hyphaema + 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 center and
may take up to 2 yrs.
 DEEP CORNEAL OPACITY:
* Oedema of corneal stroma
* folds in the Descemet's membrane. 3/27/2017By / Salwa Dohim

11. Sclera
 Partial thickness scleral wounds occur alone or
with other lesions of closed globe type.
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12. Anterior chamber
 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
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13. Iris , pupil and ciliary body
 TRAUMATIC MIOSIS:
occurs initially due to irritation of ciliary nerves or with spasm of
accommodation.
 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
* Anti-flexion * Retro-flexion
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14.  TRAUMATIC ANIRIDIA:
the completely torn iris from ciliary body
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, characterized 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.
TTT: consist of atropine , antibiotics and steroids.
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15. lens
 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 fibers
rosette cataract
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16.  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
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18. VITREOUS
 Liquefaction and appearance of clouds of fine
pigmentary opacities.
 Detachment of the vitreous either anterior or
posterior.
 Vitreous hemorrhage .
 Vitreous herniation in anterior chamber may occur
with subluxation or dislocation of lens.
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19. Choroid
 Rupture of choroid: is concentric to optic disc and situated
temporal to it and can be single or multiple.
On fundus examination :
whitish crescent with fine
pigmentation at its margins .
Retinal vessels pass over it.
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20. - Choroidal hemorrhage 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.
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21. Retina
 COMMOTIO RETINAE(Berlin’s oedema):
It manifests as milky white cloudiness involving of posterior pole
with a cherry- red spot in the foveal region .
disappear after some days 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.
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22.  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.
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23. IOP changes in closed globe injury
 TRAUMATIC GLAUCOMA
 TRAUMATIC HYPOTONY
it may follow damage to the ciliary body.
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24. Traumatic changes in refraction
 Myopia may follow ciliary spasm or rupture of zonules or
anterior shift of lens
 Hypermetropia and loss of accommodation may result
from damage to the ciliary body(cycloplegia).
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25. 2- GLOBE RUPTURE
It is a full-thickness wound 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 eye wall
TREATMENT:
A badly damaged globe should be enucleated .
In less severe cases it can be repaired under general anesthesia.
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26. Eye lids lesion Conjunctival Injury Orbital injury Optic n. Injury
- Laceration and avulsion of
lids may occur .
subconjunctival
hemorrhage
-fracture of orbital walls.
-Orbital hemorrhage
sudden proptosis
-Orbital emphysema may
occur following ethmoidal
sinus rupture
associated with
fracture of base
of skull
3- Extraocular lesions
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30. You can refer to :
 http://eyewiki.aao.org/Ocular_Trauma%3A_Acute_Evaluation,_Cataract,_G
laucoma
 http://www.medscape.com/viewarticle/813605
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31. Merci Bien
Take care of your Eyes ..
3/27/2017By / Salwa Dohim