Eye Care Blog

Contusions

Severe blows to the face and eyes are relatively rare in life; but casual blows and knocks are common, occurring mostly in the home or on the sports field. For those involved in warfare they are common enough injuries. Explosions exert great changes of air pressure upon the body, followed by a rebound as the pressure suddenly drops again. This is the invisible fist of the battlefield, and of some industrial accidents. The eye can be convulsed from its muscle connections and the orbit severely damaged. Most explosions are also associated with flying debris (it could be shrapnel, it could be glass), so that injury is often compounded by different types of damage. Other instances where contusive damage occurs are motor accidents, especially where safety belts are not worn, champagne bottle corks, squash balls and fireworks.

They all exert considerable pressure on the front of the eye, and produce similar results. The eye is compressed or squashed in its front-back axis. The iris may be torn, in which case blood pours into the front chamber of the eye. Further, the inner lens can be dislocated and even pushed into the posterior of the eye. Sudden pressure on the retina may again cause damage, seen as oedema (fluid swelling) and haemorrhages in the tissue. Even with slight injuries late effects can occur. In all instances where the injury has resulted in loss (partial or otherwise) of vision immediate and expert attention is essential. If the concussion is very severe, the globe of the eye may be ruptured and the eye itself lost. The best, and sometimes only, cure is prevention, by the adoption of rigorous safety standards wherever accidents and/or explosions can possibly happen. This applies particularly to sporting activities. Wherever protective devices such as guards, goggles and visors have been developed they should be used.

Lacerations and Penetrations of the Eye

An obvious cause of laceration is flying glass splinters. A less obvious cause is a child crawling through a hawthorn bush. The point of a thorn passes through the cornea and penetrates through the inner lens of the eye with resultant cataract formation. There are many bizarre situations that have led to eye- laceration, from objects such as knives, forks, pens, and knitting needles, and the damage ranges from the trivial to the severe.

Take, for instance, a dog bite. The dog’s teeth often catch the lower lid, tearing or dividing it. Here the globe of the eye has remained unharmed, but even so the drainage system of the eye is put in jeopardy, and expert attention is needed to prevent complications. Unless the eye is expertly repaired the patient will always suffer watery eyes. Where injury is more severe, the eye may stop functioning and eventually shrivel up, so that either a coloured contact lens or a pair of dark glasses have to be worn permanently.

Following such injuries, and depending on the cause, legal advice is often sought. Whom can I sue? If the injury was suffered at work during the operation of a particular industrial process, then the trade union concerned will take up the case of the individual. Once a legal claim for compensation is made, a long process of investigation to establish cause and effect must be undertaken before a settlement can be obtained. This usually involves several visits by the patient to specialists so that appropriate reports can be filed. In some instances a claim will not be considered until all treatments have been completed.

This can, for some patients, mean several years of anxiety. The injured person waiting for a claim to be met may not psychologically wish to work, or earn a living, for fear of prejudicing his or her claim to benefit. Eventually, when a claim is settled, much of the proceeds will have to be handed over to the lawyers and doctors (where private medical facilities have been used). On the other hand, there are instances where the emotive background to the case results in some very high damages being given, even out of all proportion to the injury suffered. In some countries the jury determines the level of damages, in other countries the judge does so. Some lawyers use a contingency agreement, whereby their fees are paid as a percentage of the final award. One can only hope that in time a more dignified method of assessing and deciding claims will be worked out.

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