Eyelid & Orbital Trauma

Ocular trauma involves injury or damage to the eye, eyelid, or the surrounding bone around the eye. Eye injuries are extremely common with over two million cases reported every year in the United States that require medical treatment. Patients who have eyelid and/or orbital injuries often present with pain in and around the orbit accompanied with bruising, bleeding, swelling, and sometimes facial numbness. They also may complain in changes in vision.

Rather alarmingly, nearly one million Americans suffer an eye injury that results in visual impairment or worse. Such eye traumas are significant concern and the leading cause of monocular blindness. Blindness in one eye is most commonly due to cataract in the United States and this is followed closely by eye injuries. In children, injury to the eye is 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, domestic injuries are now occurring more commonly 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 emergency departments have shown that amongst all the eye injuries, those that occurred due to contusion 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% (oftentimes scissors). 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 welding is the most common cause of work-related eye injuries (over 30%). 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%.

In terms of the types of eyelid/orbital trauma, approximate statistics are as follows:

  • Photokeratitis (painful UV light exposure) is the most common type of injury at 33%
  • Laceration of the eyeball and penetration by a foreign object forms 22% of the total number of types of injuries
  • Chemical burns account for 14% of injuries
  • Foreign body and corneal abrasions account for 12% on injuries
  • Injury to the adnexa of the eye amounts to 9%
  • Blunt trauma to the eye 5%
  • Serious scalding burns at 4%

The numbers above show startling results. At Idaho Eyelid and Facial Plastic Surgery, we have seen many patients experiencing eyelid and orbital trauma. From what we have witnessed, these situations arise from an assortment of events in/around the Treasure Valley, such as: car accidents, dog bites, fist fights, accidental and intentional wounds inflicted from gunshots, golf club injuries, fireworks, fish hook penetration, and many others. Our eyelid and orbital trauma experience, from orbital fracture restoration to skin grafting to restore facial symmetry, makes our Practice one of the best resources for eye injuries in Boise, Idaho.

That said, eyelid and orbital trauma prevention can go a long way. 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.

Resources to prevent eye injuries are worth examination. 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 do-it-yourself activities involving sharp tools, mowing the lawn and opening bottles of champagne. Some good advice follows:

  • Patients who suffer from poor mobility and who are at high risk of falling should have cushioning placed over sharp edges and corners.
  • 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 should be avoided as the risk of injury is much 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 ideally be avoided. When children are using sharp objects such as paperclips, pencils and scissors, supervision is strongly recommended. Children with dogs/cats should also be supervised.

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.

Eye Injury Symptoms

While available literature and studies demonstrate that individuals have an understanding of how injury occurs to the eye and methods of prevention, accidents still happen. Symptoms of ocular trauma are presented below:

  • Closed globe injury or non-penetrating trauma: although the eye globe is intact, there is still blunt trauma.
  • Penetrating trauma: the globe integrity is disrupted by a full-thickness entry wound and may 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: caused by blunt trauma and leading to fracture of the floor or medial wall of the orbit due to sudden increased pressure on the orbital contents.

Immediate 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. Idaho Eyelid and Facial Plastic Surgery has the experience and know-how to help manage your eye injuries and restore facial symmetry and vision. In the unlikely case that the eye is severely damaged to the extent that it must be removed, an artificial eye may possibly be inserted. There is no way to restore vision to the eye in this instance.


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