Eyelid and Orbital Trauma

Trauma to the eye, eyelids, orbit and facial bones can occur due to many causes. Motor vehicle accidents are the cause in many patients. Penetrating trauma to the periocular structures can be due to bullet wounds, stab wounds, arrow wounds and many other sharp and blunt objects. Trauma to the structures and tissues around the eyes maybe commonly associated with injury to the eye, facial bones, brain, chest and abdomen.

The soft tissues of the eyelids are easily damaged in many trauma patients. It is not uncommon for the lacrimal gland which lies under the upper outer eyelid to be injured. In addition, the muscles which open and close the eyelid, the tarsal plate (collagenous structure which provides a framework for the eyelid), the tear drainage system and the extra ocular muscles (which move the eyeball) can be easily damaged. Repair of these injuries depends upon the extent of the injury and is individualized to the patient.

The bones of the orbit (eye socket) are often broken with blunt or penetrating trauma to the head and face. The thinnest bones in the face are floor and medial wall of the orbit. When fractured, these bones can “trap” the soft tissue in the orbit and cause double vision, a sunken appearance to the eye and numbness to the cheek (blowout fracture). More severe trauma can fracture the bones of the forehead and cheek which can impair visual function and cause loss of vision, double vision and painful movements of the eye. It is common to wait several days from the time of injury to repair to allow soft tissue swelling to resolve.

Many eye injuries can be prevented if protective eye wear is used at work or during sports activities. If an injury does occur, prompt first aid may greatly improve the chances of preserving vision. Injuries involving chemicals such as alkalis and acids require immediate irrigation of the eye with neutral solution. For injuries from foreign bodies or from blunt or penetrating objects, a protective shield should be placed over the eye. In all cases, emergency care by a qualified ophthalmologist or ophthalmic plastic surgeon should be quickly sought.