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DESCRIPTION: May be non-penetrating or penetrating; if non-penetrating, can be due to abrasion (usually corneal or conjunctival), contusion, or burns. Although abrasion injuries are painful, they usually heal quickly after treatment. Contusions may result in hemorrhages (a "black eye," subconjunctival bleeding, vitreous and or retinal hemorrhaging), ruptures (of the cornea, root of the iris or iris sphincter, dislocation of the lens, choroidal rupture and/or retinal detachment), paralysis or spasm of the muscles of accommodation, or optic nerve injury. Secondary complications of contusion may be traumatic cataract or secondary glaucoma. Thermal burns damage eye tissue much as they do other skin tissues, but corneal burns may result in opaque scar tissue. Ultraviolet irradiation (e.g., unfiltered ocular exposure to an electric welding arc) can produce a superficial keratitis (which is painful but usually heals quickly). Solar macular burns cause permanent visual damage; excessive X-ray exposure produces later cataractous changes.

Penetrating injuries include corneal and conjunctival foreign bodies (which usually heal well and produce no visual loss unless the central cornea is involved), lacerations (both of the lids and of the eyeball), and intraocular foreign bodies. The prognosis for lacerations depends on the extent (depth) of the wound, and whether there has been any loss of ocular contents.

Intraocular foreign bodies are the most serious type of penetrating wounds. Identification and localization of the object is essential, since some materials (e.g., glass or porcelain) may be tolerated and left alone, while others (e.g., copper or iron) must be removed because of later chemical reactions within the eye. Moreover, damage to ocular structure and/or tissue must be detected prior to treatment decision.

TREATMENT: Treatment varies according to the type and extent of the wound. Most superficial wounds are painful but heal well with treatment. Subconjunctival hemorrhages appear worse than they are, and usually self-absorb in time. Internal ocular injury is less visible and always requires examination by a medical eye specialist. ALL EYE INJURIES, WHETHER SUPERFICIAL OR SERIOUS, SHOULD BE SEEN AND TREATED BY AN OPHTHALMOLOGIST.

IMPLICATIONS: Tetanus inoculation is indicated whenever the eye is penetrated by injury.