Eye  Injuries

Eye injuries can be serious, involving several parts of the eye and are usually quite painful. Eye injuries are a common cause of loss of vision in children.  The National Society to Prevent Blindness states that about one-third  of eye loss in children younger than the age of 10 is  from injury to the eye. Injury from sports is very common. 

Some of the more recurrent  injuries occur during the following activities: 

• hockey  
• archery  
• darts  
• BB guns 
• bicycling  
• sports  that involve rackets 
• baseball  
• boxing  
• basketball  
• Other common causes of injury to the eye include the following: 
• chemicals  
• toys  
• fingernails  

Is it an emergency? 

Any injury to the eye of  your child should be considered a medical emergency, and immediate medical care is necessary. Often, a younger child with an injury to the  eye may need to be examined in the operating room under general anesthesia. Ophthalmologists (physicians who specialize in comprehensive eye care) are usually involved in the care of children with eye injuries. 

Types  of eye injuries 

There are many different types of eye  injury that require clinical care by a physician or other healthcare professional.

Corneal Abrasions:  A corneal abrasion is a scratch or injury to  the cornea, the clear, dome-shaped  surface that covers the front  of the eye. This is a very common occurrence in children. There are many things that can cause an abrasion to the cornea. The more common causes include foreign bodies in the eye (such  as dirt, pebbles, insects); a scratch from a toy  or fingernail; contact lenses in older children. When these objects have contact with the surface of the eye, a small abrasion can occur. 

Chemical burns:  These occur when a child gets any type of chemical in his/her eye. Chemical burns are a medical emergency, and the child should receive immediate medical care. Chemical burns can result in a loss of vision and even a loss of the eye itself, if not treated promptly and accurately. Household cleaning agents are a common cause of  this type of injury. 

Hyphema: This refers to blood in the anterior chamber of the eye. The anterior chamber is the front section of the eye's interior where fluid flows in and out, providing nourishment to the eye and surrounding tissues. A hyphema is usually caused by a  injury to the eye. Blood is seen in the eyeball. This is a medical emergency and immediate medical care is necessary. 

Bruising or Black Eye (Ecchymosis):  Ecchymosis, or  more commonly known as a "black eye," usually occurs from some type of injury to the eye, causing the tissue around the eye to become bruised. Your child's physician will examine the eye closely to make sure there is no damage to the actual eye itself. 

Fractures of the orbit:  When one  or more bones surrounding the eye are broken, the condition is called orbital fracture. The orbit is the bony structure around the eye. An orbital fracture usually occurs after some type of injury or a strike to the face. Depending on where the fracture is located, it  can be associated with severe eye injury and damage. 

Eyelid lacerations:  Eyelid lacerations are cuts to  the eyelid caused by injury. Your child's physician will examine the eye closely  to make sure there is no damage to the eye itself. An ophthalmologist (physician who specializes in comprehensive eye care) may also examine  your child for further evaluation of  the eye. 

Foreign bodies:  Foreign bodies refer  to any objects that are in  the eye that are not meant to be there. The foreign object  may be in the conjunctiva (a thin membrane that covers the actual eye) or in the cornea (the clear, dome-shaped surface that covers the front of the eye). 

What are the symptoms of eye injuries? 

For information on symptoms  for specific types of eye injuries mentioned above, link to any of the following: Corneal Abrasions, Chemical Burns, Hyphema, Bruising or Black Eye (Ecchymosis), Fractures of the Orbit, Eyelid lacerations, Foreign Bodies. Generally, some symptoms of eye injuries can include: 

• blood in the eyeball 
• changes in  the shape of the iris or pupil 
• eye pain 
• sometimes no obvious symptoms 

How are eye injuries diagnosed? 

Some eye injuries are not detected because no symptoms are present. When an eye injury is suspected, a physician should be consulted. A physician  can usually locate foreign matter in the eye by examination with  a magnifying glass under good light. If no foreign matter is present, a child's eyes and surrounding area are examined to determine the presence and possible seriousness of an injury. During examination anesthetic eye drops  may be administered  to lessen eye pain. 

To help locate scratches and other small injuries,  the eye  is stained with an orange dye called fluorescein. This dye appears bright yellow under  a blue examining light; with it, highlighted scratches and scrapes on the eye can be detected. 

More serious eye injuries may involve imaging studies such as x-ray or computerized tomography scans. For more information on how eye injuries are diagnosed, link to specific injury listed above under "What are the Symptoms  of Eye Injuries." 

How are eye injuries treated? 

Specific treatment for an orbital fracture will be determined by your child's physician based on: 

• your child's age, overall health, and medical history 
• extent  of the injury 
• the location of the fracture 
• your child's tolerance  for specific medications, procedures,  or therapies 
• expectations for  the course of the injury 
• your opinion or preference 
• Foreign matter 

Foreign matter in the eye usually requires only simple treatment. Blinking often forces sand or dust out of the eye, but  a moistened cotton swab can also be used  for removal. If  the foreign matter is embedded in  the eye, treatment should not be attempted at home. Your child should be taken  to the emergency room. A physician may apply surface antibiotics once the object is removed. 

Scratched cornea 
A scratched cornea usually heals without complications. Pain relievers  and surface antiobiotics may be prescribed. The treatment  of cuts vary according to the extent of the injury. A small cut usually does not need stitches, but a severe cut to the eyeball requires immediate treatment and usually requires surgery. 

Chemical burns 
Emergency action is required when a child's eye has come in contact with chemicals. The affected eye should be immediately flushed with running water, and the child should be taken to an emergency room. To ease the pain, a physician may apply a surface anesthetic. If eye damage is severe, surgery may be necessary. 

Eyelid lacerations 
If the laceration is simple, as determined by your child's physician, the cut will be sutured (stitched). Local anesthetic drops may be placed in the eye prior to the suturing. The sutures will usually be taken out five to seven days after the injury. Sedation or general anesthesia may be needed  for younger, uncooperative children. For larger lacerations, or if there is any involvement of the eye, an ophthalmologist may be consulted to evaluate and treat the wound. 

Hyphema (blood in the eye) 
Most children with hyphema should be treated in an emergency room. Treatment includes  eye drops, a patch over the eye, and avoiding activities like reading to prevent movements of the eye. 

Ecchymosis (bruised or black eye) 
Most black eyes heal completely and do not cause any damage to the eye. Treatment may include cold compresses to the eye for the first 24 hours, followed by warm compresses to the eye until the swelling stops. The child's head should be elevated to help decrease  the amount of swelling. It is important to know that the swelling and bruise  may appear to spread and go down the cheek or to the  other eye. This is normal. Consult your child's physician if the bruising  and swelling does not resolve on its own. 

Fractures  of the orbit 
Your child should consult with an opthalmologist to decide on treatment. In some cases, treatment  may be delayed to allow for  the swelling and bruising to go down. Double vision should resolve without treatment within three to four days. In severe fractures, or if the eye is involved, surgery may be needed.