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Blunt trauma

This usually results from fist, sport injury (tennis or squash ball injury).

Presentation:

  • Black eye is common due to skin ecchymosis
  • Painful eye results from corneal abrasion and rarely raised intraocular pressure
  • Reduced vision from hyphaema or retina contusion
  • Double vision may occur due to blow-out fracture or introrbital haemorrhage


Examination:

  • Corneal abrasion is best seen by instillation of fluorescein dye and examine 

  • with a blue light
  • Hyphaema may show up as blood level in the anterior chamber
  • The pupil may be dilated due to traumatic mydriasis
  • Posterior segment examination with direct ophthalmoscope is usually difficult 

  • due to swollen lid, abrasion or hyphaema.
Management:
    Refer the patient within 24 hours after seeing to exclude any serious ocular 
    injury which may include:
      • hyphaema
      • cataract
      • retinal oedema
      • retinal haemorrhage
      • globe perforation (rare)
      • blow oud fracture.
Figure 1
Picture showing potential site of haemorrhage in blunt trauma.

Figure 2
This patient suffers a traumatic corneal abrasion. Note the fluorescein 
stained area of abrasion (appears as green).

Figure 3
An eye with hyphaema (note the blood clot in the anterior chamber).
Figure 4.
A child with a right iridodialysis (avulsion of the iris root) from blunt
trauma.

Figure 5.
This young man was assaulted two weeks earlier and sustained a left 
black eye. He complained of double vision on upgaze when the swelling 
resolved. The picture shows restricted left upgaze caused by orbital
floor fracture.

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