Published: 2021-11-24

Difference between penetrating versus blunt ocular trauma in diagnosis, treatment and complications

Ahmed Thabit Alnahdi, Ahmed A. Alaamri, Abdullah K. Alajmi, Malak K. Alkuwaykibi, Ruba A. Bati, Abdulaziz A. Alrabee, Fawaz M. Salman, Sahar Y. AlHawsawi, Ridha S. Aldrees, Abdullah N. Shablahah, Hussain M. Alhasani


Ocular trauma can be broadly classified into open and closed injuries. However, many subclassifications were reported based on the causative object and extent of the injury. The diagnosis and management of the various ocular traumas are different based on the underlying etiology, the severity of the case and the potentially related complications. Accordingly, in the present study, we aimed to conduct a thorough discussion about the diagnosis, treatment, complications of the blunt and penetrating ocular traumas and the potential differences between the two types of injuries. Our findings indicated that the diagnosis of the conditions mainly differed in the step of obtaining an adequate history from the affected patients based on the diagnosis of the condition that can be established. Furthermore, a routine examination should also be performed for both cases to enhance the prognosis and preserve vision. In addition, prognosis is usually worse in cases of penetrating or perforating injuries where eye inoculation might be indicated in severe cases. A detailed description of this information is provided within the manuscript based on the etiology of the underlying ocular injury and the related prognostic outcomes.


Ocular injury, trauma, Management, Treatment, Diagnosis, Complications, Penetrating, Perforating, Blunt, Rupture

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Canavan YM, Archer DB. Anterior segment consequences of blunt ocular injury. Br J Ophthalmol. 1982;66(9):549-55.

Eagling EM. Perforating injuries of the eye. Br J Ophthalmol. 1976;60(11):732-6.

Bauza AM, Emami P, Soni N, Holland BK, Langer P, Zarbin M, et al. A 10-year review of assault-related open-globe injuries at an urban hospital. Graefes Arch Clin Exp Ophthalmol. 2013;251(3):653-9.

Gyasi M, Amoaku W, Adjuik M. Epidemiology of hospitalized ocular injuries in the upper East region of ghana. Ghana Med J. 2007;41(4):171-5.

Ramirez DA, Porco TC, Lietman TM, Keenan JD. Ocular injury in United States emergency departments: seasonality and annual trends estimated from a nationally representative dataset. Am J Ophthalmol. 2018;191:149-55.

Sukati V. Ocular injuries-a review. Afr Vision Eye Health. 2012;71(2):86-94.

MacEwen CJ. Ocular injuries. J Royal Coll Surgeon Edinburgh. 1999;44(5):317-23.

Desai P, MacEwen CJ, Baines P, Minassian DC. Incidence of cases of ocular trauma admitted to hospital and incidence of blinding outcome. Br J Ophthalmol. 1996;80(7):592-6.

Thomas R, McManus JG, Johnson A, Mayer P, Wade C, Holcomb JB. Ocular injury reduction from ocular protection use in current combat operations. J Trauma. 2009;66(4):99-103.

Mohseni M, Blair K, Bragg BN. Blunt eye trauma. Treasure Island (FL): StatPearls Publishing; 2021.

Mwangi N, Mutie DM. Emergency management: penetrating eye injuries and intraocular foreign bodies. Commun Eye Health. 2018;31(103):70-1.

Nemet AY, Asalee L, Lang Y, Briscoe D, Assia EI. Ocular paintball injuries. Israel Med Assoc J. 2016;18(1):27-31.

Hoskin AK, Yardley AM, Hanman K, Lam G, Mackey DA. Sports-related eye and adnexal injuries in the Western Australian paediatric population. Acta Ophthalmologica. 2016;94(6):407-10.

Gelston CD. Common eye emergencies. Am Fam Physician. 2013;88(8):515-9.

Zungu T, Mdala S, Manda C, Twabi HS, Kayange P. Characteristics and visual outcome of ocular trauma patients at Queen Elizabeth central hospital in Malawi. PloS One. 2021;16(3):0246155.

Ram J, Verma N, Gupta N, Chaudhary M. Effect of penetrating and blunt ocular trauma on the outcome of traumatic cataract in children in northern India. J Trauma Acute Care Surg. 2012;73(3):726-30.

Rahman I, Maino A, Devadason D, Leatherbarrow B. Open globe injuries: factors predictive of poor outcome. Eye. 2006;20(12):1336-41.

Blanch RJ, Good PA, Shah P, Bishop JR, Logan A, Scott RA. Visual outcomes after blunt ocular trauma. Ophthalmology. 2013;120(8):1588-91.

Yucel OE, Demir S, Niyaz L, Sayin O, Gul A, Ariturk N. Clinical characteristics and prognostic factors of scleral rupture due to blunt ocular trauma. Eye. 2016;30(12):1606-13.

Wang BH, Robertson BC, Girotto JA, Liem A, Miller NR, Liff N, et al. Traumatic optic neuropathy: a review of 61 patients. Plast Reconstr Surg. 2001;107(7):1655-64.

Kuhn F, Maisiak R, Mann L, Mester V, Morris R, Witherspoon CD. The ocular trauma score (OTS). Ophthalmol Clinic North Am. 2002;15(2):163-5.

Kuhn F, Morris R, Witherspoon CD, Heimann K, Jeffers JB, Treister G. A standardized classification of ocular trauma. Ophthalmology. 1996;103(2):240-3.

Katz SE. Ocular trauma: principles and practice. LWW; 2003.

Smith D, Wrenn K, Stack LB. The epidemiology and diagnosis of penetrating eye injuries. Acad Emerg Med. 2002;9(3):209-13.

McGwin G, Xie A, Owsley C. Rate of eye injury in the United States. Arch Ophthalmol. 2005;123(7):970-6.

Scott R. The injured eye. Philo Transaction Royal Soc Biolog Sci. 2011;366:251-60.

Potockova A, Strmen P, Krasnik V, Olah Z. Mechanical injuries of the eye. Bratislavske Lekarske Listy. 2010;111(6):329-35.

Napier SM, Baker RS, Sanford DG, Easterbrook M. Eye injuries in athletics and recreation. Surv Ophthalmol. 1996;41(3):229-44.

Huang Z, Chen L, Zeng Y, Lin C. Clinical features of perforating eye injuries complicated with intraocular foreign bodies located at the posterior global wall. Eye Sci. 2013;28(4):180-4.

Lee DE, Ryoo HW, Moon S, Ahn JY, Kim JH, Kim JY. Epidemiology and risk factors for sports- and recreation-related eye injury: a multicenter prospective observational study. Int J Ophthalmol. 2021;14(1):133-40.

Weichel ED, Bower KS, Colyer MH. Chorioretinectomy for perforating or severe intraocular foreign body injuries. Graefe's Arch Clinic Experiment Ophthalmol. 2010;248(3):319-30.

Cinotti AA, Maltzman BA. Prognosis and treatment of perforating ocular injuries. John Luhr memorial lecture. Ophthalm Surg. 1975;6(4):54-61.

Cass SP. Ocular injuries in sports. Curr Sport Med Reps. 2012;11(1):11-5.

Thompson CG, Kumar N, Billson FA, Martin F. The aetiology of perforating ocular injuries in children. Br J Ophthalmol. 2002;86(8):920-2.

Beby F, Kodjikian L, Roche O, Donate D, Kouassi N, Burillon C, et al. Perforating ocular injuries in children: a retrospective study of 57 cases. J Fr Ophtalmol. 2006;29(1):20-3.

Apoorva MN, Hamsaveni V. Ocular injuries-a review article. JAIMS. 2018;3(5).

Cleary PE, Ryan SJ. Experimental posterior penetrating eye injury in the rabbit. I. Method of production and natural history. Br J Ophthalmol. 1979;63(5):306-11.

Mackiewicz J, Machowicz-Matejko E, Sałaga-Pylak M, Piecyk-Sidor M, Zagórski Z. Work-related, penetrating eye injuries in rural environments. Ann Agri Environment Med. 2005;12(1):27-9.

Smith D, Wrenn K, Stack LB. The epidemiology and diagnosis of penetrating eye injuries. Acad Emerg Med. 2002;9(3):209-13.