Trauma and Neoplasms of the Eye

An orbital fracture is a break in the continuity of one or multiple bones of the eye socket, caused by direct or indirect trauma to the orbit. Patients frequently present with lacerations around the eye, orbital pain, edema, ecchymosis, diplopia on upward gaze, numbness around the eye, and signs of muscle entrapment. Diagnosis is based on clinical exam and imaging. The mainstay of management is to prevent further injury to the eye while determining whether surgery is needed. Complications include orbital compartment syndrome, blindness, and persistent diplopia.

Corneal abrasions, erosions, and ulcers are classified as corneal epithelial defects. These defects are differentiated according to their depth: abrasions are into the corneal surface epithelium, erosions involve the corneal epithelium and epithelial basement membrane, and ulcers extend into the underlying stroma. Corneal defects are commonly caused by injury to the eye by foreign bodies, spontaneous causes such as corneal epithelial dystrophy, or infections. These injuries are diagnosed with proper history taking and physical examination. Slit-lamp examination is used for confirmation. Treatment includes use of topical lubricants, analgesics, antibiotics, and an eye patch. Minor surgical procedures are used in treating erosions. Complications include infections, loss of vision, perforation, and irregular astigmatism.

Retinoblastoma is a rare tumor but the most common primary intraocular malignancy of childhood. It is believed that the condition arises from a neuronal progenitor cell. Retinoblastoma can be heritable or nonheritable. The condition typically presents as unilateral or bilateral leukocoria (abnormal white reflection in the eye) in a child under the age of 2. Retinoblastoma is fatal if not treated but early recognition accounts for a high survival rate in resource-rich countries.