Clinical Review ABC of Eyes

Injury to the eye

BMJ 2004; 328 doi: (Published 01 January 2004) Cite this as: BMJ 2004;328:36

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  1. P T Khaw,
  2. P Shah,
  3. A R Elkington


    An injury to the eye or its surrounding tissues is the most common cause for attendance at an eye hospital emergency department.


    How the injury was sustained gives clues about what to look for during the examination. If there is a history of any high velocity injury (particularly a hammer and chisel injury) or if glass was involved, a penetrating injury must be strongly suspected and excluded. If there has been a forceful blunt injury (such as a punch), signs of a “blowout” fracture should be sought. The circumstances of the injury must be carefully recorded as they may have important medicolegal implications. It may not be possible to get an accurate and reliable history from children if an adult has not witnessed the injury. Such injuries should be treated with a high index of suspicion, as a penetrating eye injury may be present.

    The injured eye


    A good examination is vital if there is a history of eye injury. Specific signs must be looked for or they will be missed. It is vital to test the visual acuity, both to establish a baseline value and to alert the examiner to the possibility of further problems. However, an acuity of 6/6 does not necessarily exclude serious problems—even a penetrating injury. The visual acuity may also have considerable medicolegal implications. Local anaesthetic may be needed to obtain a good view, and fluorescein is essential to ensure no abrasions are missed.

    View this table:

    Corneal abrasions

    Corneal abrasions are the most common result of blunt injury. They may follow injuries with foreign bodies, fingernails, or twigs. Abrasions will be missed if fluoroscein is not instilled. The three aims of treatment are to:

    • Speed healing and protect the eye—pad the eye

    • Prevent infection—apply chloramphenicol ointment

    • Relieve pain—instil a cycloplegic drug (cyclopentolate 1% or homatropine 2%) and give oral …

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