Contusion

The eye casualty officer comes to recognise a familiar pattern of contusion, the effect of squash ball injuries and blows from flying objects in industry or after criminal assault. Injuries from industrial causes have now become quite uncommon thanks to better control by means of protective clothing and proper guarding of machinery. As a result, sporting injuries have become more evident, although here increasing public concern has also led to some improvement. Notable instances of good control are the use of protective guards in ice hockey and cricket. The surrounding orbital margin provides good protection to the eyes from footballs and even tennis and cricket balls, but the rare golf ball contusion injury usually leads to loss of the sight of the eye. Squash balls and especially shuttle cocks have earned a bad reputation for inflicting contusion injuries and, from the economic point of view, leading to loss of time at work and hospital expenses.

The extent of damage to the eye from contusion depends on whether it has been possible to close the eyelids in time before the moment of impact. If the lids have been closed, bruising and swelling of the eyelids is marked and the injury to the eye might be minimal. It must be remembered though that this is not an infallible rule and the eyes themselves must always be carefully examined, even when there is extreme swelling of the lids. It is always possible to examine an eye, if necessary using an eye speculum under general anaesthesia. In the primary care situation, one must be very careful not to apply more than gentle pressure to the eyelids in case the globe of the eye has been perforated and when there is doubt, referral to the eye department is advisable. The important clinical features of contusion injury are best considered by looking at the anatomical parts of the eye.

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