Trauma (blunt)
The CMGs are guidelines on the diagnosis and management of a range of common and rare, but important, eye conditions that present with varying frequency in primary and first contact care.
The CMGs are guidelines on the diagnosis and management of a range of common and rare, but important, eye conditions that present with varying frequency in primary and first contact care.
Blow to the eye: accidental (e.g. RTA, industrial, domestic, sports) or non-accidental (e.g. fist)
Also known as ocular contusion
Usually unexpected but may be vocational (e.g. boxing)
Pain varies from mild to severe
Epiphora
Visual loss (variable)
Photophobia
Possible diplopia
Mild cases (usually with good corrected vision)
Severe cases (usually with some loss of visual function)
Other causes of acute red eye
Pre-septal cellulitis
Practitioners should recognise their limitations and where necessary seek further advice or refer the patient elsewhere
GRADE* Level of evidence and strength of recommendation always relates to the statement(s) immediately above
Careful history required, including mechanism and time of injury
Lid oedema: cold compress to ease swelling
(GRADE*: Level of evidence=low, Strength of recommendation=strong)
Systemic analgesia e.g. paracetamol, aspirin, ibuprofen
Non-steroidal anti-inflammatory drug (e.g. ibuprofen) where there is significant tissue swelling
(GRADE*: Level of evidence=low, Strength of recommendation=strong)
In cases of corneal abrasion consider topical antibiotic
(GRADE*: Level of evidence=low, Strength of recommendation=weak)
Management depends on severity of injury
Mild cases:
B2: alleviation or palliation; referral unnecessary
Severe cases:
A2: first aid measures and emergency (same day) referral to A&E
Assessment and investigation including imaging (e.g. X-ray, CT, MRI)
Treatment of globe rupture where present
May require hospital admission
*GRADE: Grading of Recommendations Assessment, Development and Evaluation (www.gradeworkinggroup.org)
Sources of evidence
Alteveer J, Lahmann B. An evidence-based approach to traumatic ocular emergencies. Emergency Medicine Practice 2010;12(5):1-21
Betts T, Ahmed S, Maguire S, Watts P. Characteristics of non-vitreoretinal ocular injury in child maltreatment: a systematic review. Eye (Lond). 2017;31(8):1146-54
Kuhn F, Morris R, Witherspoon CD, Mester V. The Birmingham Eye Trauma Terminology system (BETT). J Fr Ophtalmol. 2004;27(2):206-10
Lecuona K. Assessing and managing eye injuries. Community Eye Health. 2005;18(55):101-4
Sihota R, Kumar S, Gupta V, Dada T, Kashyap S, Insan R, Srinivasan G. Early predictors of traumatic glaucoma after closed globe injury. Arch Ophthalmol. 2008;126(7):921-6
Yew CC, Shaari R, Rahman SA, Alam MK. White-eyed blowout fracture: Diagnostic pitfalls and review of literature. Injury. 2015;46(9):1856-9
The eye is well protected by the bony structures of the face that surround it (brow, cheek, nose) but it is sometimes injured by a direct blow, which is usually accidental but is sometimes the result of an assault. In mild cases this often results in bruising and swelling of the tissues around the eye (a ‘black eye’) which resolves fully in time leaving no after-effects; painkillers may be the only treatment needed. In more severe cases one or more of the bones of the orbit (the bony cavity in which the eyeball sits) may be fractured and this may cause the eye or one of the muscles that moves it to be displaced. The blow to the eye may also damage the structures inside the eye and
may cause internal bleeding or raised eye pressure. Such cases need to be referred as emergencies to the ophthalmologist.
Trauma (blunt)
Version 12
Date of search 17.08.17
Date of revision 30.01.18
Date of publication 09.05.18
Date for review 16.08.19
© College of Optometrists
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