This usually occurs in sporting accidents e.g. football to the eye or from fights/assaults. If it is a large object, the orbit will usually absorb most of the impact:
- Close inspection/palpation of the orbit should be done to rule out any blowout fracture (if suspected, a CT may be required)
If the blunt object is smaller, or if the force of a big object is large, the globe may take some impact. Haemorrhage may occur, and can sometimes be seen as hyphaema (a collection of blood in the anterior chamber).
- The severity of hyphaema can be graded:
- Layered blood occupying less 1/3 of the anterior chamber
- > 1/3 but < 1/2
- > 1/2
- Total (or blackball, 8-ball)
- The main concern about hyphaema is a rise in intra-ocular pressure, which occurs in most cases due to blockage of the trabecular meshwork with erythrocytes and fibrin.
- IOP may be high initially, then subsequently falls (can appear normal) due to < aqueous production and development of uveitis. This can sometimes cause further haemorrhage and a secondary haemorrhage and rise in IOP (often more concerning)
- Mild grade 1 hyphaemas often don’t require any treatment- blood will be reabsorbed and the eye should recover. More severe and any recurring haemorrhage will probably require bed rest, pressure control (beta-blocker), mydriatics and patching (steroid drops may also be required to reduce any secondary inflammation).
Any patient with visual loss following blunt injury should be referred and investigated. Patients may also incur haemorrhage in the vitreous humour (vitreous haemorrhage) which can increase the chance of subsequent retinal detachment. The patient may also develop synechia(e) and are at increased risk of developing traumatic glaucoma.