Eyelid & Orbital Trauma

Eye injuries are extremely common with over 2 million cases reported every year in {the} United States that require medical treatment. Rather alarmingly, nearly 1 million Americans suffer an eye injury that results in visual impairment and blindness. Blindness in one eye is most commonly due to cataract in {the} United States and this is followed closely by eye injuries. In addition, in children, injury to {the} eye is a recognized as {the} most common cause of blindness in one eye that is not due to a birth defect.

Statistics show that nearly 2000 US workers suffer injury to their eyes at their workplace on a daily basis. However, statistics now revealed that these injuries are occurring more and more commonly at home to {the} extent that nearly 4 to 5 out of 10 injuries occur at home. Sports and recreational activities account for over 40% of eye injuries. The incidence of eye injuries tends to be a lot higher in men than in women, with a rate of nearly 7.3 to 1. Most injuries occur at around 20 years of age with just over a third of them occurring under {the} age of 17 years.

Clinical studies conducted in {the} emergency Department have shown that amongst all {the} eye injuries, those that occurred due to confusion or abrasion are {the} most common (44.4%), followed closely by foreign bodies (30.8%), burns (10.2%), conjunctivitis (9.9%), laceration (1.8%) and puncture wounds (0.5%).

Amongst {the} different ways that individuals suffer an eye injury, {the} foreign body in {the} eye accounted for 44% while injury to {the} eye by an object accounted for 33%. Burns accounted for 12%, machinery injuries accounted for 2.1%, motor-vehicle crashes 2.3% and eye injuries following a fall at 1.8%.

Given how common work-related eye injuries are, studies have shown that {the} welding is {the} most common cause of work-related eye injuries, forming 30.4% of {the} total number. Drilling and cutting accounted for 13.4%, chemical injuries 11.7%, hammering 10.2%, cleaning and maintenance of equipment 7.1%, mowing 6.4% and grinding at 6%.




Photokeratitis was {the} most common type of injury at 33.2%. Laceration of {the} eyeball and penetration by a foreign object forms 22.3% of {the} total number of types of injuries. Chemical Burns accounted for 14.1% while foreign body and corneal abrasions 12.4%. Injury to {the} adnexa of {the} eye amounts to 9.2%, blunt trauma to {the} eye at 4.9% and serious scalding burns at 3.9%.

Clearly {the} numbers and graphs above demonstrate startling results.

When looking to treat eye injuries, it is important to prevent them as well. Educating {the} public, using safety equipment and being aware of risks associated with certain activities can prevent 9 out of 10 eye injuries. Interestingly, only 18% of workers who work in high-risk areas wear corrective eyewear and not surprisingly there appears to be a strong relationship between {the} development of eye injuries and {the} lack of wearing suitable protective eyewear.

The available literature and studies have demonstrated that individuals have a good understanding of how injury occurs to {the} eye and what protective measures they have to follow. However, whether or not this knowledge or education plan is successful is still doubtful. Of course, there is always an exception to {the} rule and in {the} case of {the} Canadian Amateur Hockey Association, recognition that over 65% of {the} players sustained injuries to {the} face and their eyes led to {the} development of full face protective masks during playtime. Subsequently, {the} number of injuries sustained on {the} face and eyes during hockey games dropped dramatically from 257 in 1974 all {the} way to 0 in 1983.

Similarly, in 1984, helmets and face masks were used in conjunction with each other in {the} Little League baseball teams. Amongst 4233 Little League baseball players, using a protective mask significantly reduced {the} incidence of injury to {the} face and eyes from {the} oncoming baseball (adjusted ratio 0.65).

Numerous recommendations have been made by {the} American Academy of Ophthalmology regarding preventing eye injuries at work, in a recreational environment and at home. These guidelines and recommendations can be found at www.geteyesmart.org/eyesmart/living/preventing-eye-injuries.cfm. Preventing eye injuries at home can be easily achieved by using protective eyewear when handling household chemicals, cooking food with hot oil, performing DIY using hammers and nails, mowing {the} lawn and opening bottles of champagne. Patients who suffer from poor mobility and who are at high risk of falling should have cushioning placed over sharp edges and corners.

Similarly, at work, it is strongly recommended that all individuals who are operating machinery that places their eyes at risk must wear protective eyewear at all times. This is particularly applicable when performing tasks that an individual has not done before as they would be unaware of {the} risks. Operating heavy machinery when tired must be avoided as {the} risk of injury is a lot higher in such situations. Protective eyewear must be worn when working with glass as {the} dust that emerges from it can cause injury to {the} eyes. Similarly, working in dusty environments would also warrant {the} use of protective eyewear.

During recreational activities, children are at a higher risk of developing eye injuries. Sporting activities such as baseball, soccer, racket sports and football can all place a child had a higher risk of developing facial or eye injuries. Playing with toys such as BB guns, potato guns, fireworks and lawn darts should be ideally avoided. When children are using sharp objects such as paperclips, pencils and scissors, supervision is strongly recommended. Dog bites might occur and in {the} event that they do, euthanizing {the} dog or removing {the} dog from {the} premises completely is strongly advisable.

In a hospital setting, it is important to have an education programme and enhanced {the} patient’s awareness regarding eye injuries. Displaying an eye injury prevention screensaver can be a useful way of raising awareness and reducing {the} incidence and prevalence of facial and eye injuries. This can be implemented during {the} Eye Injury Prevention Month set forth by {the} American Academy of Ophthalmology.

Utilizing {the} following resources can be helpful for both patients and health care practitioners looking after patient’s eyes.

  1. The Occupational Health & Safety Administration that operates through {the} Department of Labor has an online e-tool that discusses safety measures that must be adopted at {the} workplace along with {the} ideal protective eye-wear that must be worn depending upon {the} job done and {the} surrounding environment. You can read more here - www.osha.gov/SLTC/etools/eyeandface/index.html
  2. The American Academy of Ophthalmology also has a guide on protective eye-wear. Read more here - www.geteyesmart.org/eyesmart/living/protective-eyewear.cfm
  3. July is {the} Eye Injury Prevention Month - {the} way of preventing injuries that arise due to an increasing use of fireworks during this month. You can see what {the} dangers of fireworks are here - youtu.be/Hll41lFzIB0

If you wish to learn more about eye injury prevention, {the} links below will certainly be of help.


  • www.cdc.gov/niosh/topics/eye/
  • www.foh.dhhs.gov/Public/NYCU/eyeinjury.asp
  • www.foh.dhhs.gov/nycu/eyeinjury.asp


Effects of eye injury

  • Closed globe injury or Non-penetrating trauma: The eye globe is intact, but {the} seven rings of {the} eye have been classically described as affected by blunt trauma.
  • Penetrating trauma: The globe integrity is disrupted by a full-thickness entry wound and might be associated with prolapse of {the} internal contents of {the} eye.
  • Perforating trauma: The globe integrity is disrupted in two places due to an entrance and exit wound (through and through injury). This is a quite severe type of eye injury.
  • Blowout fracture of {the} orbit is caused by blunt trauma, classically described for fist or ball injury, leading to fracture of {the} floor or medial wall of {the} orbit due to sudden increased pressure on {the} orbital contents.

Quick attention to {the} injury as well as possible need for plastic and reconstructive surgery are important to restore {the} proper function as well as cosmetic appearance.

If {the} eye is damaged to {the} extent that it must be removed, an artificial eye might inserted. There is no way to restore vision to {the} eye in this instance.

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