This usually results from fist, sport injury (tennis or squash ball injury).

Presentation:

• Black eye is common due to skin ecchymosis
• Painful eye results from corneal abrasion and rarely raised intraocular pressure
• Reduced vision from hyphaema or retina contusion
• Double vision may occur due to blow-out fracture or introrbital haemorrhage

Examination:

• Corneal abrasion is best seen by instillation of fluorescein dye and examine 

with a blue light
• Hyphaema may show up as blood level in the anterior chamber
• The pupil may be dilated due to traumatic mydriasis
• Posterior segment examination with direct ophthalmoscope is usually difficult 

due to swollen lid, abrasion or hyphaema.

Refer the patient within 24 hours after seeing to exclude any serious ocular 
injury which may include:
• hyphaema
• cataract
• retinal oedema
• retinal haemorrhage
• globe perforation (rare)
• blow oud fracture.

Figure 1 Picture showing potential site of haemorrhage in blunt trauma.

Figure 2 This patient suffers a traumatic corneal abrasion. Note the fluorescein  stained area of abrasion (appears as green).

Figure 3 An eye with hyphaema (note the blood clot in the anterior chamber).

Figure 4. A child with a right iridodialysis (avulsion of the iris root) from blunt trauma.

Figure 5. This young man was assaulted two weeks earlier and sustained a left  black eye. He complained of double vision on upgaze when the swelling  resolved. The picture shows restricted left upgaze caused by orbital floor fracture.

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