Non-Penetrating Eye Injury
Description Diagnostic criteria Medicine treatment Referral ICD-10 code: S05.1 DESCRIPTION An intact cornea and sclera, but severely contused eye. A foreign body on or embedded in the cornea of an intact eye. DIAGNOSTIC CRITERIA Signs depend on the site affected and nature of the non-penetrating trauma. Corneal injury Contusion: hazy oedematous cornea. A foreign body embedded on/in the corn
Description
Diagnostic criteria
Medicine treatment
Referral
ICD-10 code: S05.1
DESCRIPTION
An intact cornea and sclera, but severely contused eye.
A foreign body on or embedded in the cornea of an intact eye.
DIAGNOSTIC CRITERIA
Signs depend on the site affected and nature of the non-penetrating trauma.
Corneal injury
- Contusion: hazy oedematous cornea.
- A foreign body embedded on/in the cornea.
Iris injury
- Sphincter rupture: dilated or irregular pupil margin.
- Hyphaema: blood in the anterior chamber due to rupture of the blood vessels.
Lens injury
- Cataract: reduced red-reflex.
Lens suspensory ligaments
- Subluxed or dislocated lens: abnormal lens position.
Retinal injury
- Blood vessel injury: blood in vitreous or blood on/in the retina.
- Retinal breaks and tears.
Choroidal injury
- Choroidal break: blood or sclera visible under the retina.
Optic disc
- Disc swelling or pallor.
MEDICINE TREATMENT
Corneal injury
A superficial corneal foreign body may be removed with a bud or hypodermic needle.
To anaesthetise the cornea for removal of a foreign body:
- Topical anaesthetic, e.g. oxybuprocaine, ophthalmic drops, instil 1 drop. Repeat every 15 minutes, if necessary.
To relieve discomfort caused by iris spasm:
- Atropine, 1% ophthalmic drops, 1 drop instilled immediately and 12 hourly until epithelialisation is complete.
- Chloramphenicol, ophthalmic ointment, applied 8 hourly for 5–10 days.
Iris injury
Sphincter rupture
Manage conservatively. Follow-up in four days to exclude hyphaema.
Hyphaema (blood behind the cornea)
Bed rest for five days.
Monitor for complications, i.e. increased intraocular pressure, corneal staining, secondary bleed.
- Atropine, 1% ophthalmic drops, instil 1 drop 12 hourly for 5 days.
PLUS
Topical corticosteroid drops:
- Dexamethasone, ophthalmic drops, instil 1 drop 4 hourly for 5 days.
REFERRAL
- A deeply embedded or full thickness corneal foreign body.
- Hyphaema, if unable to monitor for complications or if complications develop.
- Any eye with severe trauma and decreased visual acuity.
- Lens, retina and choroidal injuries – refer within 12 hours.
Standard Treatment Guidelines and Essential Medicines List for South Africa Paediatric Hospital _2023, 5th edition_Updated July 2024
Chapter 16: Eye Conditions, 16.7 Non-penetrating Eye Injury