SEEING Beyond Abuse

National Domestic Violence Hotline Blog

SEEING Beyond Abuse

By Jessica L. Young, O.D. | Pennsylvania Optometric Association’s 2010 Young Optometrist of the Year

Many may think that visiting an eye doctor would be the last place for an abuse victim to go.  After reading this article, you may disagree. One day, a 49 year-old woman came to see me for a routine eye examination. Her vision was getting a little worse and she thought, “Maybe I need a new pair of glasses.” During the examination, I noticed a tear in the iris of her right eye.

Upon checking her eye pressure I found that it was elevated in her right eye. I asked the woman if she had ever sustained any injuries to her eyes. She confirmed that she had in fact been hit many times in her eyes and face years ago by a former boyfriend. I explained how the trauma had damaged her eye and the increased eye pressure could lead to optic nerve damage and vision loss if left untreated. We decided to begin medicated eye drops to lower the eye pressure. So far the drops are successfully keeping the pressure down, reducing her chances of vision loss. This woman very well may have lost her eyesight had she not happened to come for a regular eye exam.

Physical assault resulting in trauma to the eye can have both immediate and lasting effects. If trauma to the eye occurs, urgent medical attention should be sought to treat any immediate damage. Visiting an eye doctor is prudent for anyone who has ever sustained trauma to the eye at any time. This is because a form of glaucoma, called traumatic or angle recession glaucoma, can occur months or even years after an eye injury.

Glaucoma is the second leading cause of blindness in the United States. But what is glaucoma? The eye contains fluid, which is constantly being produced and drained. This fluid creates a pressure inside the eye (intraocular pressure) and helps the eye keep its shape. If this pressure becomes too high, it can damage the nerve inside the eye (the optic nerve), which can result in permanent vision loss. This is glaucoma.

When the eye undergoes trauma, the damage that occurs can lead to glaucoma. The fluid in the eye is drained where the cornea (the front clear window of the eye) meets the iris (the colored part of the eye); this is called the angle. This drainage angle can be damaged during a traumatic event such as a strike to the eye. When the angle is damaged, the fluid may not drain properly, which can cause the eye pressure to increase and can then lead to glaucoma. This is a special type of glaucoma: angle recession, or traumatic glaucoma.

In the United States, over 1 million Americans experience eye injuries each year. Blunt eye injuries account for over 60% of these injuries, and over 10% of all eye traumas are due to assault[1]. Damage to the eye angle (called angle recession) is one of the most common complications after a strike to the eye[2].  Though infrequent, damage to the eye angle can lead to angle recession glaucoma. This can occur weeks, months, or even many years after the trauma to the eye has occurred. As with most other forms of glaucoma, symptoms of vision loss are not noticed until the glaucoma is advanced and the damage is extensive. In fact, glaucoma is often called the “sneak thief of sight”. Since traumatic glaucoma can occur long after the eye has been injured, it is very important not only have an initial eye examination, but also regular visits to an eye doctor.

At the first visit to an eye doctor, it is necessary to mention any previous eye or head trauma so the eye can be properly evaluated for angle recession and glaucoma. The doctor will check the eye angle with a special lens, measure the eye pressure, and evaluate the optic nerves for any signs of damage. If angle recession is found, regular follow-up visits will be needed to monitor the eye for angle recession glaucoma. If glaucoma is detected, the doctor will likely start prescription eye drops to lower the eye pressure and try to prevent further damage to the optic nerve.

The Centers for Disease Control and Prevention estimate that 1.3 million women are victims of physical assault by an intimate partner each year. One in every four women will experience domestic violence in her lifetime. Domestic violence is a serious problem and a common cause of injury.

I urge anyone who has ever sustained an eye injury, especially victims of domestic violence or child abuse, to schedule an examination with an eye doctor. Please mention your history of eye trauma so the eyes can be properly evaluated

[1] American Academy of Ophthalmology.  2009 Eye Injury Snapshot Project Results.

[2] Sullivan, Brian R.  Angle Recession Glaucoma.

* It’s rare to get an eye doctor’s perspective on domestic violence. We thank Dr. Young for reaching out to us and sharing this important piece of information. *

Comment section

0 replies
  1. You’re quite right when you say that a domestic violence victim is not likely to report all the injuries to doctors and hospitals for fear that the medical professionals would have to report the abuse to the authorities when, in fact, the AMA urges to first and foremost to treat the victim for his/her injuries and informed them of resources that they can obtain help from, including the National Domestic Violence Hotline number of 1-800-799-7233.

    Thanks for bringing out the point about the lasting effects of the injuries. I’m not sure that many victims, even if they do go to the emergency room for assistance with their immediate injuries, would necessarily think to follow up with the eye doctor, for example, for injuries to the eyes.

    Great point and thanks for sharing.

  2. Ironically, this week I had an eye exam and found out I have traumatic glaucoma in the left eye. Yes, my X abuser was right handed, and the injuries were many years ago. I had no idea of this until 2 days ago when they did routine testing then asked me about any injuries. They could tell, years and years later by doing digital exam and other routine eye exams that my optic nerve is damaged.
    I went home googled the topic and found this article and cried. I am not a victim. I am a survivor. Am I? When is the damage going to stop being done?

  3. Exactly, Jennifer. I’m a survivor too — twice over.

    I have regularly seen an ophthalmologist throughout the years because I wear glasses (sometimes contacts) and have migraines; however, I’m not remembering a time that they ever asked me if I had any eye injuries. I can’t count how many black eyes I had during both of those domestic violence relationships.

    I know that there are many victims/survivors out there. It is something indeed that we should be talking to them about, especially in the economic conditions where people cut out their preventative care maintenance when it comes to medical care due to the expenses involved and many people not being able to afford insurance.

    When someone mentions that they have head injuries (been hit in the head), we are quick to say that they must immediately have it checked out because they could lead to other conditions such as concussions and seizures and more. How many times when we see someone with a black eye do we urge them to get medical treatment as well? The poster mentions that it could potentially lead to blindness; now, that is a very serious consequence. How often would we not get medical attention to our eyes if we were truly aware that our eyes could be permanently damaged with blindness?

    It certainly gives family/friends one more opportunity for a conversation with a someone that may still be in that volatile, toxic, violent relationship.

    Jennifer, I’m glad that your testing revealed the damage so that you can get the treatment today and not potentially lead to continual damage. Just imagine how many are out there that aren’t getting the follow up testing. Too, perhaps, the testing has improved technology wise that damages can be better detected these days.

    I’m needing to get my eyes checked for a possible new prescription. After reading this article, I’m certainly going to make it a priority.

    Jennifer, too, I am with you. I feel your frustration. Surviving should mean that in whole and not in part. Ughghgh. The consequences of the injuries at the time are huge in themselves at the time; we should not have to continue to suffer consequences years and possibly decades later. Hopefully, improved technologies will help detect the injuries earlier so that preventative measures from it worsening can take place; although, hopefully we can too get victims/survivors to take a better stance in getting the medical attention at the earliest point in time.

  4. My ex used to hit and kick me a lot, and spit on me too…we’ve ben separated for a couple years, but it still bothers me so much, will it ever end? He acts like it all never even happened. Of course he acts like I always deserved it. He choked and kicked me in front of our little kids. I never pressed charges and now going through a divorce and custody the courts don’t help me.

  5. Nicole:

    Unfortunately, because we sometimes have children with our abusers, it does seem like it never ends because of that connection that they hold with us — the children. Courts can seem like a frustrating series of events – especially when it comes to divorce and custody issues. A legal advocate at the local domestic violence shelters can serve to guide you in some direction on this; if you haven’t already been connected to a legal advocate in your area, please call the hotline at 1-800-799-7233 and we can certainly match you up with a legal advocate in your area.

    Insofar as custody issues, you might also find the following resources, handy:

    Women’s Law Resource

    Legal Resource Center on Violence Against Women (interstate custody issues)
    Survivor Hotline – 800-556-4053

    Legal Momentum (legal resource kits on divorce and custody)

    Stop Family Violence (helpful articles on custody & family violence, including relocation)

    Justice for Children (advocacy for children who have been failed by CPS, Law Enforcement & the court system)
    Hotline – 800-733-0059 (based in Houston, TX)

    Kourts for Kids (advocacy for child protection in courts)

    If you still run into seemingly a brick wall, please feel free to call us 24/7 at 1-800-799-7233 for other possible ideas or strategies.

    NDVH Hotline Advocate_kk

  6. Thank you all for your interest in my article and for sharing your personal stories. Our country is very fortunate to have the National Domestic Violence Hotline available to provide free and confidential help 24/7. I hope that you all find the support and assistance that you are looking for and much deserve.

    Best Wishes,

    Dr. Young

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