Blunt Ocular Trauma
Ophthalmology: Trauma & Emergency Management
1. Birmingham Eye Trauma Terminology (BETT)
The standard classification system for eye trauma:
- Closed Globe: No full-thickness wound of the eyewall. (Includes contusion and lamellar laceration).
- Open Globe: Full-thickness wound of the eyewall. (Includes rupture and laceration).
2. Common Blunt Injury Manifestations
| Injury Type | Clinical Finding |
|---|---|
| Hyphema | Blood in the anterior chamber. Monitor IOP; risk of rebleed. |
| Iridodialysis | Tearing of the iris from the ciliary body attachment. |
| Lens Dislocation | Subluxation or complete dislocation (phacodonesis). |
| Commotio Retinae | “Berlin’s edema”—whitening of the retina post-trauma. |
| Choroidal Rupture | Crescent-shaped tear, often temporal to the optic disc. |
3. High-Yield NEET Pearls
- Hyphema Management: Bed rest (head elevation), cycloplegics, and topical steroids. Avoid NSAIDs (aspirin) due to bleeding risk. If IOP is high, use systemic anti-glaucoma agents.
- Rupture Location: The eyeball most commonly ruptures at the weakest points: the **limbus** or **behind the insertion of recti muscles**.
- “8-Ball Hyphema”: Total hyphema with secondary glaucoma; requires surgical evacuation.
- Evaluation: Always perform a Seidel’s test to rule out occult open globe injury. If rupture is suspected, stop examination and protect the globe with a rigid shield.