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Eye Injury

A patient came to see me this week, who had accidentally knocked a paper bag against her left eye three days prior and sustained a painful but fortunately not serious eye injury. Immediately she got a painful scratch, and a small haemorrhage became visible on the front white of the eye.
She saw her optician who tested her vision, dilated her pupils and looked at the back of her eye. He could not find anything amiss but advised her to have an ophthalmology examination within a few days. Therefore, she came to see me as part of our urgent eye care service. I fully examined her injured eye, including imaging the retina and optic disc using the SLO, and also looking in more detail at the structures at the back of the eye, the macula, in particular, using the OCT. The special ocular imaging tests use the latest and most sophisticated machines to show the tiniest retinal detail.
She had to have dilating drops for me to get the best view of all the retina and vitreous (clear gel filling the inside of the eye). That was fine as she was not driving. Eye drops can blur the vision a lot, so we always advise against driving for two to four hours afterwards.
I then put a special examining contact lens on the front of the eye under local anaesthetic, which is called a three mirror. Via the mirrors of that lens, I could look right out at the periphery of her retina and reassure her that although she had a floater, she did not have any loose bits of the retina or retinal tears. There was no retinal detachment. There was no posterior vitreous detachment, and I could reassure her entirely.
A blunt trauma such as that of a full paper bag of shopping can potentially cause damage inside the eye, as well as the more obvious external painful corneal scratch (corneal abrasion). Therefore, we consider a comprehensive examination of the inside and back of the eye using ocular imaging to be important.
By the time I have seen her three days after the eye injury, the corneal abrasion was better, and there were just a subconjunctival haemorrhage and a floater at the back of the eye. Fortunately, she did not have anything worse. There was no internal ocular damage. Neither had she got a deeper cut on her eye. She had not caused inflammation of the eye, and she had not got a retinal tear. Only by her prompt visit to her optician and then subsequently to me, was she able to reassure both herself and her family that it was not likely there was going to be any permanent eye damage.

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