It is worth learning and using the terminology from BETT:

The BETT, however, is less good for describing the mode of injury which can be from blunt objects as in assaults from Þsts, feet, wooden bats or from other causes, for example, balls in sport, air bags (Han 1993; Pieramici and Kuhn 2003; Pearlman et al. 2001), paintballs (Mason et al. 2002) and bungee elastic cords (Cooney and Pieramici 1997), from sharp instruments such as broken glass, knives or fragments of metal.

Trauma was a very early indication for the use of vitrectomy (Peyman et al. 1980; Coleman 1982; Conway and Michels 1978; Ryan 1978; Mody et al. 1978; Mandelcorn 1977; Hutton et al. 1976), with increased experience and availability of techniques leading to improved success rates (Pieramici et al. 1996a).

Fig. 14.1 The Birmingham Eye Trauma Terminology is a useful method for classifying trauma and allows adequate communication between surgeons

Fig. 14.3 This patient was struck by a weight from a Þshing line and has suffered a blunt injury which damaged the upper lid. It caused a hyphaema and also an optic nerve avulsion

Fig. 14.2 This patientÕs cornea shows severe staining of the corneal stroma after hyphaema from a severe injury to the eye from an assault. This can make visualisation of the posterior segment difÞcult during PPV. Usually with corneal opacities, it remains possible to visualise through a segment of clear cornea, in rare cases a keratoprosthesis (e.g. Ekhart) is required

Fig. 14.4 This patient has suffered an iris root dialysis from a blast injury during a terrorist bomb attack. The eye was hypotonous for many weeks post injury but Þnally recovered to 20/20 after a cataract extraction

Fig. 14.5 The patient suffered a typical traumatic sunßower cataract

Fig. 14.6 The vitreous in the AC in this patient with contusion injury indicates zonular dehiscence. The patient had lenticulodonesis which was too unstable for routine phacoemulsiÞcation cataract extraction and required PPV and cataract extraction with anterior chamber lens insertion

Fig. 14.7 Angle recession is visible in a patient who suffered a blunt injury whilst shaking out wet clothing when the metal zip of a shirt hit her eye

Fig. 14.8 Paintball gaming is associated with blunt injuries to the eye when the participants remove their goggles to clear them of condensation and are struck in the eye by paint pellet. This patient suffered an iridodialysis and rupture in the posterior lens capsule which caused a rapid-onset cataract (see Fig. 14.9)

Fig. 14.10 Two months after the injury with the paintball an extensive posterior subcapsular cataract has developed

Fig. 14.12 This eye was struck by squash ball. There are minimal signs on the exterior of the eye

Fig. 14.13 The eye was Þlled with vitreous haemorrhage and rolled up retina could be seen near the macula

Fig. 14.11 This patient was punched in the eye causing a subretinal haemorrhage which is likely to have an underlying choroidal haemorrhage, vision was 20/20

14.3.1 Clinical Presentation

Presentations of contusion injury:

1.Subluxated or dislocated lens

2.Vitreous haemorrhage

3.Macular oedema and commotio retinae

4.Retinal detachment

(a)Dialysis usually with a Ôbucket handleÕ vitreous base avulsion

(b)Giant retinal tear

(c)Ragged retinal tear in an area of commotio retinae

(d)Pars ciliaris tear

5.Late retinal pigment epithelial changes

6.Macular hole

7.Choroidal rupture, haemorrhage

8.Choroidal neovascular membrane

9.Optic nerve avulsion

Contusion injuries occur when the eye is struck by an

object, but the eye wall remains intact. This is common in assaults from the use of Þsts or feet or from injury from balls in sport but can also be encountered from air bags (Han 1993; Pieramici and Kuhn 2003; Pearlman et al. 2001), paintballs (Mason et al. 2002) and bungee elastic cords (Cooney and Pieramici 1997). In mild injury, the retina shows commotio (whitening) which clears after a few days, sometimes accompanied with macular oedema (BerlinÕs oedema). Vision can be lost from macular oedema, commotio retinae, choroidal rupture, lens dislocation, glaucoma, hyphaema, retinal detachment, choroidal haemorrhage and

Fig. 14.14 After removal of the vitreous haemorrhage, a large area of severe corioretinal damage was found. PVR developed postoperatively causing folding of the retina over the disc and transretinal Þbrosis at the edge of the scar

Fig. 14.16 After removal of the PVR membranes and inferior retinectomy, the retina is ßattened

Fig. 14.17 Squash ball injury; 10 months after removal of the silicone oil, the retina remains stable, the traumatic scar in the macular and temporal retina can be seen. Note the retinectomy edge inferiorly and nasally

Fig. 14.15 Notice removal of the transretinal Þbrosis and ßattening of the fold over the optic disc after surgery

vitreous haemorrhage. Corneal staining can result from hyphaema and choroidal neovascular membrane from choroidal rupture. The retina may show late retinal pigment epithelial changes from diffuse retinal damage.

Lens dislocation may occur in patients with pseudoexfoliation or pseudophakia or in highly myopic eyes.

Ultrasound is helpful to assess the type of haemorrhage in patients with medial opacities to determine prognosis for vision and surgical options. Traumatic macular hole formation may occur.