Every year thousands of people are involved in accidents which causes trauma to the face. High speed automobile accidents, rough sports injuries, cases of violent assault, occupational hazards etc are some of the most common causes of trauma to the face and the eyes. Blunt trauma to face and eyes can cause multiple and sometimes even fatal injuries.
Eyes are very delicate and their proper functioning is crucial. When the eyes and the orbital area sustain a heavy injury, ripple damage is done. In case of trauma to the eyes, the orbital bone can get fractured and also the eyelids and the eyeball can sustain damage. Sometime the canalicular, which is the tear duct, may also suffer major damage.
Trauma surgery of the eyes and the associated structure depends upon the part of the eye which has sustained damage.
The injuries to the canalicular are treated with surgery. After any eyelid trauma, it is assumed that the canalicular is damaged, and the treatment is done accordingly. Blunt or sharp injury to the periocular area may cause disruption in the canalicular. If the injury is caused due to some animal bite, the risk of rabies should also be taken in to account. The examination of the injury to the canalicular is done by physical examination. If nothing can be ascertained, the lacrimal system may be irrigated and then inspected. To further assess the depth and the extent of the injury, sometimes general anesthesia may be given. In all canalicular injuries, immediate attention is required. If there is any foreign debris in the wound, it should be immediately cleaned and disinfected. If any tissue is out of its place, it should be replaced back in its original anatomic position.
Injuries to the eyelids are also very common. A small cut on the eyelid may not require stitches but a large laceration may require them. The doctors generally primarily make a physical examination of the eyes to check for any wound that has penetrated to the eyeball. The cornea is checked for any scratches or wounds. Sometimes, severe trauma can cause injuries to the eyeball. In this case the doctor will check for the following potential complications:-
The anatomy of eyelids is complicated with the outermost layer of eyelids being skin. Under the skin various muscles are presents which help in the movement of the eyelids. The orbital septum which acts as a barrier between the superficial preseptal and postseptal tissues of the eye, is a like a sheet of fibers that lies under the orbicularis oculi muscle. In the cases there is no damage to the eyes, the lacerations of the eyelids can cause complications in the long run. If the cut runs deep in the eyelids it can prevent the muscles from opening and closing properly. It may cause permanent ptosis if not treated immediately.
Trauma to the eye may also cause fractures of the orbit which the bony socket which houses the eye. The bony edges of the socket which is called the orbital rim may also get broken due to trauma and such fracture is called orbital rim fracture. The orbital rim is quite thick therefore heavy amount of force is needed to cause this type of fracture. The obvious implication in such cases is that other injuries are sustained along with orbital bone fractures. Another type of fracture that can be sustained by the bone of the eyes is the blowout fracture. Such fracture occurs when the rim is intact but a crack forms in the thin bone that forms the eye socket. The types of fractures which are rim fractures but extend into the floor are called direct orbital floor fractures. Some of the symptoms of orbital fractures can be:-
For small injuries, surgery may not be necessary, and use of antibiotics and ice packs may be enough. But for larger fractures, immediate treatment from an ophthalmologist may be required. Sometimes, immediate surgical attention is also necessary. Sometimes, trauma may force fragments of the bones to penetrate the muscles. In such cases, an emergency surgery may be necessary.