MENU

OPHTHOBOOK-CHAPTERS

Chapter 8: Common Eye

Trauma
Timothy Root, MD 55 Comments

When I picked ophthalmology as a career, I never

dreamed there would be so many midnight
emergency room consults. Little did I know the
number of people out there punching each other
in the face and slamming their heads into airbags.
Armies of welders, construction workers, and
industrial cleaners ply their trade without proper
eye-protection. Repeated exposure to this trauma
can change your world outlook, such that I now
dread baseball season, pellet guns, and fireworks.
As odd and random as some of these injuries
seem, it’s our duty to help these people and save
those eyes!

Here are some of the common traumas you’ll

likely see coming into an emergency room.

Corneal Abrasions:
The surface of the cornea is covered by a thin
layer of epithelium. This “rug” of clear skin is only
loosely adherent and is easily scraped off. These
surface abrasions are common and we see them
daily. The cornea contains more nerve innervation
(per surface area) than any other place in the
body so these abrasions “hurt like the dickens,”
with patients complaining of excruciating pain and
intense photophobia. Abrasions are easy to see,
even without a microscope, as the raw surface will
uptake fleurosceine and glow bright green under a
blue light.

Fortunately, abrasions recover quickly and will

often completely heal within 24 hours. Until
complete epithelial healing you treat with
aggressive lubrication and follow these eyes
closely to insure the raw wound doesn’t become
infected. Many physicians will treat an abrasion
with empiric erythromycin ointment as well,
reserving more aggressive antibiotics like
ciprofloxacin for contact lens wearers and “dirty
wounds” caused by tree branches, etc..

If an abrasion does become infected, you’ll see a

white infiltrate at the wound. Any abrasion with an
infectious infiltrate is officially called a “corneal
ulcer.” Depending upon the size and location of an
ulcer, you may need to culture the wound and
tailor your antibiotic coverage accordingly.

Corneal Lacerations:
Most corneal scratches only
involve the surface epithelial
layer. If the injury goes deeper
into the stroma, then you have
a laceration. With any
laceration you want to insure
that the cornea hasn’t
perforated. You can check
corneal integrity with the “Seidel test.” You wipe a
strip of fluorescein paper over the wound and see
if dye flows down the corneal surface, indicating
leaking aqueous fluid.

If a patient is “Seidel positive” than you have an

open-globe injury – time to call in your seniors for
possible surgical repair!

Orbital Wall Fractures:

The bony orbital walls are thin and tend to break
with blunt impact to the eye. This is especially
true of the orbital floor and medial wall. These
orbital fractures are common and you will see
them weekly (usually at two in the morning).

Tim’s Bumper-Face Theory

The face is designed
like a modern crash-
tested car, with many
areas designed to
crumple and diffuse
energy upon violent
impact. The sinuses
are air-filled crumple zones that protect the brain
and other vital structures. When the eye is hit,
orbital contents (usually fat) break through and
herniate into one of these sinuses. As bad as this
sounds, this setup keeps the eye from exploding
from high impact pressures.

Most of the time these orbital bones heal fine with

no long-term problems, with patients merely
having a great deal of orbital and periorbital
swelling that resolves over a few weeks. However,
sometimes the broken bone creates a “hinge” or
“trapdoor” that entraps fat or extraocular
muscles. If there is significant entrapment or
enophthalmos, we need to repair the break.
During surgery we can release the muscle and
bolster the floor to keep orbital contents from
herniating back through the defect. This surgery
is usually performed by an oculoplastics
specialist.

When evaluating orbital fractures, focus on the

following exam findings:
1. Vision, color: Make sure the optic nerve isn’t
involved.
2. Extraocular movements: Usually decreased
from swelling or muscle contusion, but make sure
there isn’t any gross muscle entrapment. If
concerned, you can perform forced ductions. This
involves pulling on the eye with forceps to see if
the eye is mobile.
3. Proptosis: Measure the degree of proptosis or
enophthalmos using the Hertel exophthalmometer
(a fancy ruler).
4. Palpate: Feel along the orbital rim for step-off
fractures and subcutaneous emphysema (air
crepitus).
5. Sensation: Check sensation of the V1 and V2
sensation on the forehead and cheek. V2 runs
along the orbital floor and can be damaged with
floor fractures.

Most of these patients do fine and we see them a

week later with marked improvement in swelling
and motility. In the meantime, you treat empirically
with Keflex or Augmentin, advise Afrin nasal spray,
and recommend “no nose blowing” (you don’t
want to blow air from the sinuses into the orbit).

Lid Lacerations:
When evaluating lid
lacerations, you
need to determine
if the laceration
involves the lid
margin and how close the cut is to the canalicular
(tear drainage) system. Most of these lid
lacerations are straight-forward to repair, though
special effort is made to align the lid margins to
avoid lid notching and misdirected eyelashes.

If the laceration is medial (near the nose) you

need to worry about the canalicular tear system –
repair of this drain is much more involved and
involves threading silicone tubes down into the
nose to keep the canaliculus patent.

Metal on Metal:
Small pieces of
metal can fly into
the eye – an
unfortunate event
occurring primarily
in welders or construction workers. Particles of
metal stick onto the cornea causing small
abrasions and discomfort. Metal rusts quickly and
will form a rust ring within a day. You can remove
metal objects and rust rings at the slit-lamp using
a needle. You can also use a small dremel-like drill
to drill off the rust-ring. If the rust is deep, or
aggressive pursuit seems to be making the
situation worse, you can leave the residual rust in
place as most of it will eventually migrate to the
surface by itself.

Anytime you have metal-striking-metal injuries,

you must entertain the possibility of an intraocular
foreign body. Small metal fragments can enter the
eye at high speed and leave little or no signs of
injury. Metal is very toxic to the retina and can kill
the retinal cells if not detected. If you have any
suspicion for penetrating injury, you should always
order a thin-slice CT scan of the head to look for
metal pieces not obvious on exam. You want to
avoid MRI in this setting to avoid creating a
moving projectile inside the eye.

Chemical Injuries:
Household cleaners contain abrasive solvents like
bleach and ammonia that are extremely
dangerous when splashed into the eye. The first
thing you do with any chemical injury is:

Irrigate, Irrigate, Irrigate, Irrigate, Irrigate, Irrigate,

Irrigate!

The final visual outcome

for a chemical burn is
going to depend upon
how quickly the chemical
is washed out of the eye.
If a patient calls you with a
chemical conjunctivitis,
tell them to immediately
wash their eyes out! If the
ER calls you with a
chemical conjunctivitis,
tell them to start irrigating immediately – several
liters in each eye. Then grab your equipment and
pH paper and head on down there!

Acids are less dangerous than bases as acids

tend to precipitate denatured proteins and this
limits tissue damage. Bases, on the other hand,
just keep on going like the proverbial Energizer
Bunny so you need to continually irrigate and
check the pH until it normalizes.

On exam you want to carefully check the state of

the cornea – hopefully, it is still clear. A red,
inflammed conjunctiva is actually a good finding:
if the conjunctiva is white, that means its
blanched out from extreme damage. Be sure to
flip the lids and irrigate/sweep the fornices to
remove any material that may be retaining
chemicals.

Chemical injuries can lead to significant scarring

that may require corneal transplant if bad enough,
so you want to be very aggressive with that
irrigation!! The emergency room has access to a
simple device called a Morgan lens to help irrigate
via a suspended saline bag. Little kids hate this
thing and have to be restrained when using it.

FUN FACT:
Speaking of abrasives: early Romans used
human urine as a mouthwash to brush their
teeth. The ammonia has strong cleaning
powers. In fact, urine was an important
component of toothpaste well into the 1700’s.

Traumatic Iritis:
Blunt trauma to
the eye can
create swelling
and inflammation
in the front half
of the eye.
Because the
cornea is clear, we have a direct window through
which to view the inflammatory cascade. On exam
you can actually see “cell and flare” in the anterior
chamber. Cells are individual inflammatory cells
floating within the aqueous fluid while “flare” is
diffuse protein that has escaped through inflamed
blood-vessel walls.

Patients will complain of painful sensitivity to light

secondary to iris/ciliary spasm. Individual cells can
be difficult to detect at the slit lamp … and it
doesn’t help when the photophobic patient is
squeezing their eyes shut and yelling at you. You’ll
find it helpful to turn the lights completely off and
to make your light beam narrow, bright, and at an
angle (like in this drawing).

Fortunately, traumatic iritis generally runs a

benign course with resolution of symptoms within
a week of treatment. We give these patients
topical steroids to decrease inflammation and a
cycloplegic to dilate the eye. I generally use a
medium-duration dilator like Cyclogyl several
times a day – the induced paralysis of the ciliary
muscle makes the patient less photophobic. Also,
daily dilation forces the inflamed iris to move and
keeps it from sticking to the underlying lens.

Hyphema:
A
hyphe
ma
descri
bes
blood
floatin
g in
the anterior chamber, a common finding after
blunt eye trauma. If the bleed is large, the blood
will settle out in a layer at the bottom of the
anterior chamber. If the entire AC is filled with
blood, you’ll see an “8-ball hyphema.” Most of the
time, however, the bleeding is microscopic and
can only be seen as “red cells” floating in the
aqueous fluid.

Blood typically clears well, though you can get

staining of the cornea if the blood is persistant or
coexists with high eye-pressure. Encourage your
patient to sleep with their head elevated (to help
the blood settle) and to avoid straining. You
typically give steroids (to decrease the
inflammatory response) and a cycloplegic dilating
drop to help with photophobia. As with iritis, this
dilation also keeps the iris from sticking to the
underlying lens and forming synechia. With
African Americans, consider checking for sickle
cell disease. If they do have sickle cell, avoid
carbonic anhydrase inhibitors as they cause a
local acidosis that worsens sickling.

Follow these patients daily, as the bleeding can

get worse. The main danger time is days 3 to 5
because this is when clots can contract and
rebleed. You need to monitor their pressure as
blood can clog the trabecular meshwork. After the
blood has completely resolved and the eye is
quiet, perform a thorough gonioscopy exam to
access for “angle recession.” This is when the
ciliary body splits from the blunt trauma — this is a
sign (but not a causative factor) that the patient
has also likely suffered trabecular meshwork
damage and may eventually develop glaucoma in
that eye sometime in the future.

FUN FACT:
Speaking of fluid layering …
The “black and tan” tradition
of beer mixing originated
over a thousand years ago
when Viking explorers raided
the Celtic islands. The
Vikings would mix their
lighter northern beer with the local dark beers.
Later, the term “black and tan” came in use to
describe the uniforms worn by cruel British
solders sent to Ireland in the early 1920’s to
suppress uprisings.

A black and tan is most commonly

constructed with Bass Ale (an English bitter)
and Guinness (an Irish Dry Stout). The
Guinness is pored over the lighter colored
beer using an inverted spoon to disperse the
Guinness and decrease mixing. The beers
have different densities and so will remain
“layered.”

The “black and tan” is enjoyed by beer

enthusiasts who find a straight stout too
harsh. However, you may want to avoid
ordering one in Ireland because of its
historical relevance.

Open Globe Injuries:

The eye can be perforated many ways … I’ve seen
firecracker explosions, gunshot wounds, car
wrecks, and domestic accidents that have
perforated the eye. Visual outcome is usually
terrible and a blind, painful eye may need later
enucleation.

If you suspect an open globe injury you need to

evaluate the eye in the operating room. One thing
to remember – if you suspect an open globe
injury, cover the eye with a shield and don’t push
on it. You could extrude the eye contents (pop it
like a grape) if you push on the eye.

PIMP QUESTIONS
1. You have a contact lens wearer with a small
corneal abrasion. He is in excruciating pain and
requests that you pressure-patch his eye for
comfort. Will this speed up healing?
Patching may speed healing by keeping the eye
immobile and lubricated – but you should never
patch an abrasion that might fester an infection.
Thus, you don’t patch contact lens wearers as you
don’t want a pseudomonas infection brewing
under that patch! If you decide to patch a patient,
you should really follow them daily to make sure
they don’t develop an ulcer.

2. What’s the easiest way to see a corneal

abrasion? How often do you need to follow
simple, non-infected abrasions?
Abrasions are easiest seen with fluorescein under
the slit-lamp microscope, though large abrasions
can be detected with only a handlight as the
edges of the abrasion creates a circular shadow
on the iris underneath. You’ll want to measure the
epithelial defect and see them often (perhaps
daily) until it heals to make sure they don’t
become infected.

3. What is the Seidel test?

This is a method to see if a laceration has
penetrated completely through the cornea.
Basically, you’re using fluorescein to look for
leaking aqueous fluid.

4. What findings would prompt you to take a

patient with an orbital floor fracture to
surgery?
If the patient has muscle entrapment or significant
enophthalmos. Most patients have some degree
of EOM restriction from soft-tissue swelling.
Entrapment causing reflexive bradycardia would
also push you toward surgery.

5. What portion of the eyelid do you worry

about with lid lacerations?
If the laceration is medial (near the nose) it could
involve the tear drainage pathway. These
canalicular tears are more complicated to repair.

6. A patient accidentially splashes a large

amount of bleach-based cleaner in her eye.
What should she do?
Wash it out immediately – the faster, the better!!!!
If an ambulance picks her up, have the EMTs
irrigate in route, and alert the ER to irrigate her
eyes as soon as she hits the door.

7. What is the best way to test the pressure in

an eye with a likely open-globe injury: with slit-
lamp applanation or with the hand-held
tonopen?
If you suspect open globe, you don’t want to be
mashing on the eye, so neither of these is correct.
This is a trick question … hahahahaha!

8. How often should a patient with a hyphema

be seen and why?
These patients need to be seen daily for the first
week to check for pressure. This is especially
important on post-trauma days 3 – 5 as this is
when clots begin to retract and rebleed.

9. An African American presents with hyphema

after trauma. What additional workup might
you consider? Are there any medications you
would avoid?
You may consider getting basic coagulation labs
and a sickle prep. Avoid CAIs as these promote
acidosis and can worsen sickling of blood in the
anterior chamber and worsen glaucoma.

10. What two beers are most commonly used

when making a “black and tan.” Which beer
goes on top?
A black-and-tan is made with Bass Ale and
Guinness Stout – the Guinness goes on top and is
usually pored over a spoon to keep it from mixing.

Timothy Root, MD

Dr. Timothy Root is a

practicing ophthalmologist
and cataract surgeon in
Daytona Beach, Florida. His
books, video lectures, and
training resources can be
found at www.TimRoot.com

55 Comments

spencer says:

what is recommended for a patient with

traumatic iritis whose synechia doesn’t
resolve after a week of dialation and steroid
drops?

Reply

arif says:

tell me the treatment of blood vessel

rupture in sclera

Reply

admin says:

Usually, a subconjunctival bleed is harmless

and does not require treatment. The
redness will go away in a few weeks.

Reply

Linda says:

when is an abrasion likely to progress to

recurrent corneal erosion?
Symptoms/Treatment of corneal erosion.

Reply

lisa anderson says:

when i was young, a guy hit me in the eye
with a brick. since then, i having been
dealing with one eye, only to see a shadow
in the left eye. are there any way to correct
this problem. now that i am older, i want to
correct this problem, not just so i can have
vision, but for cosmetic. right now, because
this makes me look cross-eyed.

Reply

LN MD says:

i saw a trauma case more recently, and

sadly, i couldn’t help the young girl.
hopefully, after i read this chapter, i will feel
more confident and comfortable when i
encounter another ophthalmology cases
and know exactly when to refer
immediately. thanks so much for all of your
wonderful efforts and the great use of your
talent. by the way, are you planning to
create a video for this section or will it be
too gruesome?

Reply

JE-Medic says:

What is the onset of a foreign body from

the moment a metal particle enters the eye
till the time it begins to become embeded
and the cornea heals over>

Reply

athena says:

i wonder if it is correct to use systemic

steroid in order to decrease eye
inflammation after trauma ?

Reply

Jerry Pack says:

Hi Tim,

Your Dad gave me your website address

and I have spent the last hour looking at
your work.

It is very impressive. I think that your many

talents and of course your medical training
are strongly evident in this website.

Who in your field could have produced a

book and website comparable in quality to
this? I think I know the answer. Nobody!!

Keep up the good work Tim, we are all

proud of you and your accomplishments.

Uncle Jerry

Reply

Dr.Gurdarshan Singh
Bhambra says:

Nice articles for Practitioners and I found it

very useful for myself

Reply

April says:

WOW! the Eye for Dumbies I am a nurse

and ran across this site. I am glad I clicked
the link. Question…have you seen patients
with dystrophy in just one eye? Is this rare? I
was recently diagnosed with this in my OS
or the doctor thinks it could be an
unhealed abrasion chronic is a facial
trauma. Could you offer some insite to me.
Thanks, April

Reply

Helen says:

Wow, an intelligent, philanthropic, good

looking chap with a sense of humour: are
you single??

Very useful website, thank you and good

luck.

Reply

no.7 says:

we all like question no.7!!

Reply

Coleen says:

Fantastic! You make it all sooo interesting!

Great cartoons,too. Thanks from all your
techs.

Reply

Gina says:

Hello. 2 days ago, I was assisting mother-

in-law with cleaning her basement. She
used a lot of bleach during the cleaning,
which created fumes that irritated my eyes.
I removed myself from the area after I
noticed that my eyes were really tearing up.
I patted my eyes; however, I didn’t irrigate
them, as I didn’t think it was that serious.
Saturday night at about 9 pm, I was driving
and noticed that I saw halos around all the
lights outside, especially as I got closer to
the lights.

I immediately went to the emergency room.

My eyes were flushed. I explained to the
doctor that my eyes were irritated from the
bleach fumes, but not from bleach
splashing into my eyes.

Sunday evening, I still see the halos around

the lights, but they are not as severe.

The doctor told me that the ‘halo effect’

should go away within about 24 hours of
the incident;however, I still see them
Sunday night, which is about 32 hours later.

I have a follow-up appointment with the

opthamology dept today. However, please
provide your expertise with regard to this.

Reply

Dawn Carmona says:

My Grandaughter was hit in the eye 2 days

ago her eye was red & tearing ,but this
morning she said she is seeing a halo
around her eye when she looks at the light
.We went to ER,was tokd to see eye Dr. on
Monday ..If she got worse go to Philly eye
Hosp. for Children..What does this halo
mean around the eye?

Reply

Suzanne says:

Four moths ago I got weed killer in my eye,

not a splatter but I rubbed the corner, near
my nose, with my hand and the the weed
killer was on my hand. I rinsed it for a long
time, but not near enough I know now,
because it still burns four months later like I
have soap in my eye. Afterwards, it wasn’t
untill several days later that I saw my doctor
and he gave me TobraDex ST, which helped
a little bit, but the burning pain has not
gone away. My question is, after four
months, will the pain ever go away?

Reply

uzma says:

hi doctor,
m in 2nd yr of optometry
ur book is really a great blessing for
optometry students

Reply

Delphine says:

My son missed his optical bone surgery

under his left eye due to fear..he just turned
18 and was prepared to get it done at a
later date. When he returned 5 weeks later,
he was told they could do nothing. He was
told to watch for seizures, dble vision and
blindness. We were very upset. He was
informed by the triage nurse that he would
get it done if he felt ready at a later date.
We are crushed. Is there anything / options
he can do to fix this? Is surgery really out of
the question? Would he really go blind? He
still has darknes around the eye…he stll
plays video games. We are going for a
second opinion. Need to see what options
are available for him.

Reply

Chander Kanta Suri says:

There is a shrivelling at one edge of my

cornea. Removal by laser has been
recommended. Is there any urgency? Will it
spread ? Age 77. Both eyes cataract
removed over a year ago.

Reply

Chander Kanta Suri says:

Why no reaction in 4 weeks? Please e-mail

iamcksuri@yahoo.co.in

Reply

Mike H says:

Got hit it the eye by the end of a snapping

bungee cord. Went to the ER. Was totally
blind in that eye. I am being monitored. Now
two days later still cannot really see, but
with the injured eye I can detect a little light
now. Doctor cannot see in to evaluate the
retina, too clouded, by blood I suppose.
Very concerned. Also concerned about the
lens. He said it looks like I will gat a cataract
from this.

Reply

Devendra Rane says:

Recently my son got an hit with Cricket

Tenis ball in his eye. at First day in
investigation, all his scanning of eyes and
vision test were done. Everything was found
normal with very good vision. However, he
showed a good recovery in first 4 days. but
on 5th day he had high pressure in eye and
had vommitting. This again reveresed the
case back.
Further his ozzing is yet going on. He is
sleeping in inclined position so as blood
keeps moving down with gravity. His earlier
dose of Dymox which was 1 in day has been
increased to 3 per day. What could be your
opioin on this and does having this much
dymox will have any side effect. Its more to
control currently his eye pressures.

Reply

Y.Cordova says:

I have a swollen left eye,burns,stings,dry

red,gets stuck, twice i saw dark blue spots
and my rite eye is red. I went to two
doctors, one doctor said my eye looks fine
and no reason to see the opthamologist,
the second doctor said the same but
prescribed Patanol 0.1%. I dont feel any
better.I did explain that i got a cream in my
left eye that contained some type of berry
extraxt to bleach the skin that also had an
antiaging igrediant.(it was a sample,did not
have specifics.)Im scared that no one is
paying attention.I have a migrain headache
as well. What should I do?

Reply

Ervin Y Kedar says:

I am 86 years old, and back when I was 20 ,

I was injured and I had :”Choroidal
ruptuere”,”which had a cresent shape”, is it
true that it can change due to age (through
60 years)?

Reply

Lisa Douglas, Raleigh North

Carolina says:

What are the consequences of a child

washing their eyes out, over and over, day
after day with soap?
Please help my child has OCD and this is a
ritual. Her vision is declining and
hypersensitivity to light has become an
issue.

Reply

Sankalp says:

Im 14 yrs old. One and half month back

cricket ball(not leather ball, but a cork
ball)hit my left eye, in first instance
epitelium layer was out from 2-3 spot and
by mediacal aid it was recover within 2
days. but after two days misty imaages
were seen, then treatment was followed by
ultrasonoigraphy and engiography, while
both reports were O.K., but Dr. was
suspected to Glucoma and finally confirm
after 3-4 days of mediacal tests about one
month back(as per him eye injury may
followed by Glucoma in many cases but it’s
not troublesome). Medicine treatment of
Glucoma was started and eye pressure
(tension) has been under observation on
every ulternate day, and tension was
measure between 24 to 29. Finally on 21st
of this month Dr. advised for surgery since
tension is not getting down even after of
one month taking pills and now it may hurts
nerves of eye ball resulted slightly vision
loss. Then on 23rd I changed the Dr. for
better opinion, while tension was measured
34, here Dr. advised for next 15 days on
changed medicine. Now I am confused
should I continue on medicine or go for
surgery? Please please help.

Reply

michelle says:

My son bumped his eye, and now he won’t

open his eye. We dit go to dr and got
eyedrops is it normal.

Reply

Rebecca says:

Hello. This morning I noticed that there was

a swelling on the right side of my left eyelid.
It is very painful n burns slightly. Yesterday
however I was cleaning with bleach and
thought probably the fumes that were
released might been the cause since I was
cleaning in an enclosed area. Can this be
the cause? And what should I do to reduce
the swelling.

Reply

Kate black says:

Hi I was in a car accident a year & a half ago

whereby I was rear-ended & hit my head on
the head rest. I have had problems with my
right eye ever since, at times of heightened
stress it seems to throb & then I also often
get a “snow globe” affect where I see small
white particulars floating around. I had a full
eye exam & they said that there is nothing
They can do except hope it settles down in
time? I am 40 years old & have always had
great vision & no problems before this.

Many thanks for your reply, Kate

Reply

Stephanie says:

My daughter (15) was hit in the eye with a

bad basketball pass pretty hard. She didn’t
have any noticeable bleeding or swelling
and thought nothing of it, even finished the
game. A couple of days later, she noticed
when she woke up that morning that the
affected eye was ‘slow to wake up.’ She
didn’t mention it to me until several days
later. It happened again yesterday and she
admitted that it has happened a few times
since then. Yesterday, it happened in the
middle of the day while she was exercising,
the rest of the times had been while she
was waking from sleep. Any suggestions of
what might be going on? I plan to make an
appointment with the optomatrist
tomorrow.

Reply

Joy says:

This morning 12/23/12 I notice in my left eye

was red under the lid only in one spot.
There is no pain what could this be?

Reply

Amy Wilson says:

Hi,
I had a blunt eye trauma 2 weeks ago, and
orbital floor repair surgery 11days ago.
Since the surgery the white of my eye is
covered w/blood.
At times looks like it is bleeding.. About 3-4
days ago a portion of it looked a little lighter
shade of red.
This morning that lighter shade is almost as
red as it was a few days ago.
My DR said my body would absorb the
blood. It takes time, it has been over a week
with no real progress.
I am worried there is a more serious issue
here, could there be?
And if it is truly a waiting game is there
anything I can do to help speed up my
body’s reabsorbtion of this blood.
Thank you
Amy Wilson

Reply

Jeff Slotten says:

4 years ago I was injured with an exercise

band in my right eye. I developed a
hyphema and my sphincter muscle was
injured. My pupil was irregular and large. I
developed a cataract and had that removed
and my pupil tied in to appear more regular
and smaller. It does not dilate. I have to
wear close up lenses now to see print.
Before the accident I could read and use
the computer without my glasses. I
experienced annoying floaters prior to the
accident. Now if I take my glasses off and
try to look at someone within a few feet or
try to read, the injured eye feels irritated
and the floaters intensify. Also, when I blink
or look at a white or light background, I see
many fine lines as if I were looking out of a
cracked egg shell. I have followed up every
3 months with opthamologists. None of
them can help me with my problem. My eye
pressure is elevated in the injured eye and
reads about 23 versus 17 in the uninjured
eye. My life is not as comfortable as it used
to be. It is annoying having to experience
this feeling of swelling of the eye and the
little lines with lots of floaters in the field of
vision especially under bright light
conditions. Are my symptoms common with
an injury to the sphincter muscle of the
eye? What can I do to have a better outlook
for the future?

Reply

Micheal says:

Hi doctor,
 After I was punched in the head and my
brow area recently, the following next day
onwards, my left eye keep seeing a very
faint thin almost vertical moving whenver I
open my my left eye to see or whenever I
blink my left eye?

Do you think this is caused from the punch?

Also what do you think is the problem and

what can be dont to rectify it?

Thank for your attention

By the way, is it you reply our queries

directly to our email addresses we typed
above? (Becos I did not see your replies on
the above other questions posted openly
here)

Editor: Micheal, you need to see an eye

doctor right away. You are most likely
suffering from a (normally harmless) a
vitreous detachment, but new floaters
could also indicate an early retinal
detachment (potentially blinding). This can
only be diagnosed with a dilated eye exam.

Reply

Vijay Jangra says:

my both eyes have gone inside deeply. How

they will got out again and appear normal?

Reply

Laura says:

I had a corneal laceration according to a

specialist, I keep feeling something on the
corner of my upper lid towards my right ear
, it bothers me a lot, it is painful and the
doctor was concerned because my eye did
not heal in one week. It keeps hurting
specially at night, I can not lean on my right
side because the pain worsens. The Dr.
Told me that I have inflamated cells in my
cornea, however he does not know why I
have reacted like this. What can it be, the
light bothers me a lot and this did not
happen before. The Dr. Told me that the
use of a computer or reading will not affect
the healing what is your opinion? I had a
bad cornel laceration when I was a child
about 7 yrs. old and I had to wear a patch
for long time I am not sure for how long, but
why if the light bothers me a lot the Dr. Says
that it does not make any difference in the
healing process! please respond ASAP. I am
very concerned about the healing of my
eye.

Reply

walt says:

Hello good blog

can blunt force trauma affect the uninjured

eye

thanks

Reply

yemi says:

I got hit in the eye 2 days ago and since

then i noticed that everytime i go into
somewhere bright like stepping outside
even when its not yet sunny i feel a very
sharp pain in the eye even when i quickly
close it and touch the eye the pain is still
there. What can i use or do

Reply

Arianne says:

I don’t have insurance. No opthamologist

will see me. I went to the ER and they let me
discharge with the diagnosis :
opthalmoplegia / diplopia.

I just woke up this past Sunday morning

and it felt like my eyes were spinning. I
came on the web, and seen people had
women with similar issues but they went
away later in the day. So I waited one day.
The next morning I woke up and still I see
double. I go to the hospital (6/17/2013) and
they do an MRI because I also can’t taste
anything. MRI confirmed there’s been no
stroke, no MS. Bloodwprk says no diabetes.
So as I’m at the hospital I notice that I have
very little control over my right eye. I can
literally see two different directions.

Now let me back track, for a second. Before

Sunday I had an eye infection. I don’t
sterilize my make up properly and I’m used
to these infections. Usually I use baby
shampoo to clean my eyes out because its
tear free. I didn’t use baby soap this time. I
used two things I shouldn’t have used,
peroxide and shampoo. I don’t remember
which I used first. I only used the bubbles of
the shampoo, & the peroxide I had put a
drop on a q-tip. I just wanted to clean my
eye lid. Nothing happened for four days. I
had normal vision. I started cleaning my
eyes with warm sterile salt water, since I
could see the chemical burn on my eyelid.
This salt water helped with swelling, too.
Saturday came, and I didn’t use salt water.
My eye had little to no swelling, perfect
vision. (Somewhat perfect I have terrible
eye sight)

I wake up Sunday unable to see straight.

So, the ER refers me to the opthamologist
bit she wont see me because I don’t have
insurance or $175 dollars for her office visit.
I can move my eye sometimes.Sometimes
the muscles moving my eye just give out.
Will Ibe like this forever or will my eye fix
itself?

Reply

Vijay Jangra says:

Dear sir, my both eyes have gone inside

deeply. When I was child,since then my
both eyes is going inside slowly. Now They
have gone inside deeply. I am looking very
dirty. So, please tell me the treatment how
they will got out once again and will appear
normal.

Reply

Amer says:

Hi Doctor,

I was punched in the right eye recently and

my vision hasn’t been the same ever since.
An MRI and x-ray was performed and I was
told there was no fractures.

At first, I was unable to see clearly out of it

due to a large scratch on my cornea. I was
given various drops; an antibiotic, drops for
inflammation, and cyclopentolate to dilate
the eye.

I saw a doctor a week ago and was

examined and told my eye looks to be
healing fine and did not see any issues. My
vision has come back for the most part and
I stopped taking the drops 2 weeks ago.

However, my right eye remains dilated and I

have an issue focusing on near items as
well as discomfort in some occasions. It’s
most bothersome when I elevate my head
and try to shave my neck as I see 2 images
and feel a strain on my eye of some sort.
This also occurs when looking through my
left peripheral in instances while I am
driving.

I called the eye center I had visited to see if

it may be due to the drops I was taking, but
they told me no. They said it was most likely
from the eye trauma and might be
permanent damage. They also said to give
it time to see if it corrects itself.

Is there something I should be doing to help

it heal? Can this really be permanent? Is
their a procedure to correct this if so? This
has left me pretty worried and any feed
back you can provide would be highly
appreciated.

Thank You,
Amer

Reply

Linda says:

I was hit in the side of my head 3 days ago

my left eye swelled up and was swallon shut
after appying ice every 2 hours it has
oponed back up 3 days later is still soar its
turning yellow around it now how long until I
can open my eye lid up all the way my left
side of my nose is numb as well as my three
of my front teeth also it itches sometimes
where it is numb any advice would greatly
help me out thanks.

Reply

Annie says:

Hi
I got hit by a shuttlecock 1week ago. Was
order bed rest Iin hospital to settle the
hyphema. After discharge I still see blurred
vision. Latest review is blood clearing. This
is 2nd week, Iwoth spectacles the
surrounding looks fine but if I look into
phone or PCM screen the injured eye
cannot see the words is all double image.
Is this normal or the trauma cause
difference to my myopia degree?

Josann

Reply

Fernando says:

Hi,I got hit in the eye recently and now i

have rlly bad pain,some times its just plain
pain and other times its throbbing pain. i
went to the hospital for them to tell me
what was happening but it wasnt hurting
when they checked me out and they said
everything was fine but that i had a dry eye.
i put on the drops they sent me but it
doesnt help me much? is there any
possibility it could be something else?

Reply

Sue says:

my grandson had an airbag go off

yesterday morning- it hit him in the face
and his right eye is very bloodshot, his
vision is blurry and he can open his eye half
way.
Do I need to take him to the e.r.?
thank you for your input.

Reply

Tom says:

Hi Doc,

I have just walked out of E.R and have been

told that I might be allergic to something in
the air. The thing is for the last couple of
days my eye has been irritably itchy. this
morning I woke up and went to open my eye
and just the sense of a bright light really
hurt my eye likewise at night (photophobia)
but even seeing bright lights with my
opposite cause strife to my left. my eye is
that red I can’t really notice my pupil.
Doctor cannot find no foreign body, no
laceration etc but something with a high
blood flow or something with the blood
vessels. Do you have an idea what I might
have?

Reply

Mercia says:

My question actually the past 3days my left

eye started becoming a little sensitive and I
thought it will pass but this morning when I
woke and opened my eyes a watery
substance came out my left eye when it
opened,the colour of my eye inside was not
white as it should be but it looked more
light brown if I can say so,I bought eye gene
but its not helping what do U think it can be
I did not hurt my eye So I would really like to
know what it could be and what to do…
Please and thanks.

Reply

Reuben says:

I had an eye injury over 1 year ago. had a

flake of metal 3mm long 1mm thick enter
front of eye and just about exited the rear. I
had it removed that day and my lens. My
surgeon fitted some sort of gas bubble in
eye to support the rectna. after the eye
healed and bubble dissolved I had a rigid
contact lens made. When I put len on I
noticed I have diplopia (double vision) They
tried correcting it prism glasses however
they didnt work. went and saw eye
muscular specialist. He fitted me with
stronger prisms however this was the
results. If I concentrated on something I
could see singlely however whenever i
turned my head while keeping eye on
object it went back to double. everytime I
blinked it slowly went from double to single.
My vision in the injury eye with a contact is
very good however they cant get them
working together. he said to me it a 50%
chance it could go better or completely
worse. So now i have a blurred (no contact
in) double vision constantly which is very
annoying. With my contact in without
prisms I have single vision up close. I do not
understand why I have it and the doctors
seem bit confused at the whole matter.
Have you ever heard of this happening to
anyone else? Is there anything else I can
try? Eye transplant?

Reply

Timothy Root, M.D. says:

Rueben,
Your case is impossible to comment on in
this format, but I’ll make a couple of
observations:

1. It is difficult to get the eyes to work

together when one is aphakic (has no
lens or implant inside). Image disparity
between the eyes make it harder for the
brain to fuse two images from your eyes
into a single picture in the brain.

2. You have had an injury that affects the

muscle control of eye movement. In these
cases, prism can improve diplopia.
However, prism may NOT be able to
eliminate the double vision in every
direction of gaze. The goal for strabismus
doctors is to decrease double vision in
primary gaze (looking straight ahead) and
with reading, as this is the most
important for everyday activity.

3. Near vision is quite different than

distance vision. Many cross-eyed people
have no double-vision at near because
the eyes are “supposed” to cross a little
when looking at near objects. Many
people require a separate prism glass for
both distance and near.

Good luck. I would give it time. Given the

trauma you went through, I am amazed
that you have any vision at all. There isn’t
much else to try other than seeing a
different strabismus doctor for another
opinion.

Reply

jasleen says:

I touch my lens with dirty hand and its 7

days gone but still I cant use it. Its irritating.
How can I clean my lens and use it again

Reply

Danny says:

Hello,

My little boy accidently scratched my eye

and I could not sleep the night it happened
because when I blinked or closed my eye it
really hurt. I seen the Doc and he said it has
already started healing but that was like 4
months ago and every other night since I
have woken up early in the morning feeling
that stinging pain from the scratch but this
time if I shut my eye for around 15 mins the
pain dissapears and I carry on as normal.
Do you have an explanation for this?

Reply

Timothy Root, M.D. says:

Danny, sounds like a recurrent corneal

erosion. More details here:
http://www.rooteyedictionary.com/recurrent
-erosion/

Reply

Alexus says:

When I go swimming for a long time once I

get out I see a halo effect but that is just
from the long exposure to chlorine on the
eyes my right eye clears up after several
hours and then my left eye clears up after
24 hours.

Reply

amadi lucy nkeiruka says:

This is really good and educating

Pls let it continue

Reply

Leave a Reply
Your email address will not be published. Required
fields are marked *

Comment *

Name *

Email *

Website

Save my name, email, and website in this

browser for the next time I comment.

Post Comment

WANT MORE
EYE VIDEOS?
You better sign up to Dr. Root's email
list to get his latest ocular tips and
tricks!
Your Email Address:

I agree to receive rare email updates, and can

easily opt-out at any time after signing up.

SIGN ME UP, DUDE!

© 2024
TimRoot.com