Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Job Classification

In most duration tables, five job classifications are displayed. These job classifications are based on the amount of physical effort required to perform the work. The classifications correspond to the Strength Factor classifications described in the United States Department of Labor's Dictionary of Occupational Titles. The following definitions are quoted directly from that publication.

Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Contusion, Eye


Related Terms

  • Black Eye
  • Blunt Trauma
  • Ecchymosis
  • Lid Contusion

Differential Diagnosis

  • Abrasions and lacerations of the eyelids
  • Corneal abrasions
  • Foreign bodies on the surface of or within the eye
  • Fracture of facial bones, eye socket, or the skull bone near the eye
  • Hyphema
  • Lacerations of the anterior segment, cornea or sclera
  • Rupture of the globe

Specialists

  • Emergency Medicine Physician
  • Family Physician
  • Ophthalmologist

Comorbid Conditions

  • Bleeding disorders (e.g., hemophilia)
  • Other lacerations or fractures

Factors Influencing Duration

Black eyes are rarely disabling. Complications or associated injuries might influence the length of disability, particularly if surgery is required.

Medical Codes

ICD-9-CM:
921.0 - Black Eye, Not Otherwise Specified
921.1 - Contusion of Eyelids and Periocular Area
921.2 - Contusion of Orbital Tissues
921.3 - Contusion of Eyeball
921.9 - Contusion of Eye, Unspecified

Overview

Eye contusion is a bruise around the eye. It may involve the eye, eyelid, eye socket, and associated muscles and is usually the result of a blunt injury to the eye. Within 24 hours after blunt trauma, regardless of type, blood seeps out of damaged small blood vessels (capillaries) and into the surrounding tissue, forming black-and-blue areas beneath the skin (ecchymosis). Redness, swelling, and tenderness or pain may also develop. The color changes from black and blue to yellow-green over a period of days as the blood is broken down and resorbed. The eyes are particularly prone to contusions because the skin lies close to the underlying bone and there is little muscle or fat to protect fragile small blood vessels.

Incidence and Prevalence: Contusions are very common. Approximately 2.4 million eye injuries occur in the US annually ("Eye Trauma"). Approximately 165,000 work-related contusion injuries occur each year.

Source: Medical Disability Advisor



Causation and Known Risk Factors

Individuals at risk for eye contusions include people who work in occupations that expose the eye to injury, such as construction, manufacturing, or athletics; people who work with or around individuals who are combative; people who participate in high-impact sports such as basketball, hockey, boxing, football, racquetball. Other risk factors include a medical history of a bleeding disorder (hemophilia), vitamin deficiency, and use of medications that promote bleeding (e.g., aspirin, anticoagulants).

Source: Medical Disability Advisor



Diagnosis

History: The individual with a recent injury to the eye may complain of pain, swelling, and discoloration of the eyelid and surrounding area. Visual disturbances (e.g., blurred vision, double vision, loss of vision) may be reported.

Physical exam: Examination usually reveals bleeding, swelling, and tenderness in the eyelids and skin around the eye. The full extent of the contusion may not be obvious for 2 to 3 days. A thorough examination of both eyes should be performed to determine the extent of the eye injury. This includes careful examination of all portions of the eye (cornea, anterior chamber, bulbar and palpebral conjunctivae, pupil, fornices, lids, lens, vitreous, optic disk, and retina). Visual acuity, range of eye motion, and periorbital sensation are tested. The depth and size of the front chamber (anterior chamber) of the eye are noted, as well as the presence of any cuts (lacerations) or foreign bodies in the eye or eyelid, and presence of any bleeding (hemorrhage) within the eye. If there is obvious rupture of the globe, manipulation should be avoided until the individual receives general anesthesia.

Abuse may be a factor in individuals with a history of contusion and physicians should consider this during examination.

Tests: X-rays are helpful to detect the presence of an orbital fracture and / or surrounding facial bone fractures. MRI is helpful for visualization of soft tissue injuries.

Source: Medical Disability Advisor



Treatment

For minor injuries, the eyelid and area surrounding the eye is gently washed with mild soap and water. If there are abrasions or lacerations of the lids, foreign bodies on the surface of the eye, or corneal abrasions, the eye is irrigated with saline, particulate matter is removed, and antibiotic ointment and a sterile dressing are applied.

In the first 24 hours, ice packs are placed on the eyelid to reduce swelling and decrease internal bleeding. After the first day, warm compresses may be used every 1 to 2 hours to relieve tenderness and aid in resorption of the blood. Sunglasses may be worn to protect the eyes from bright light. The individual's head should be elevated during sleep until symptoms subside. Acetaminophen is usually recommended for pain; aspirin or non-steroidal anti-inflammatory drugs (NSAIDs) should not be used because of their tendency to increase bleeding. Other medications may include antibiotics to prevent infection, and / or eye drops to reduce inflammation and minimize bleeding.

If a lid, scleral, or corneal laceration has occurred, treatment may include sutures. Microsurgical techniques are used to close anterior segment wounds. Individuals with bleeding within the front (anterior) chamber of the eye (hyphema) exceeding 5% require bed rest, medication and daily re-examination of the eye. Surgical evacuation of the hyphema is necessary if the intraocular pressure remains elevated.

Source: Medical Disability Advisor



ACOEM

ACOEM's Practice Guidelines, the gold standard in effective medical treatment of occupational injuries and illnesses, are provided in this section to complement the disability duration guidelines.*
 
Eye
 
* The relationship between the MDGuidelines (MDA) content and ACOEM's guidelines is approximate and does not always link identical diagnoses. The user should consult the diagnostic codes in both guidelines, as well as the clinical descriptions, before assuming an equivalence.

Source: ACOEM Practice Guidelines



Prognosis

Uncomplicated contusions of the eye typically resolve within 2 weeks.

Source: Medical Disability Advisor



Complications

Bleeding may occur beneath the membrane that covers the eyeball (conjunctiva). The injury also could cause laceration, swelling or rupture of the cornea; hyphema; damage to the iris; bleeding in the back chamber of the eye (vitreous hemorrhage); bleeding, swelling, or detachment of the retina; fracture of the orbit; optic nerve injury; cataract; infection; or permanent loss of vision. Rarely, damaged muscle can convert into a bony substance (ossification), which may cause disfiguration. Bleeding disorders (e.g., hemophilia) can lead to a more severe contusion.

Although most of these injuries are immediately noticeable, some may not be evident for days or weeks. Ongoing bleeding inside the front chamber of the eye can result in glaucoma.

Complications occur more frequently if immediate treatment was not received.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

If visual disturbances are present, a temporary change from work duties that require detailed vision or depth perception may be necessary. The individual may be temporarily unable to wear protective goggles and / or a respirator.

Source: Medical Disability Advisor



Failure to Recover

If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case.

Regarding diagnosis:

  • Does the individual's work or play put them at higher risk for a blunt injury to the eye?
  • Does the individual have a bleeding disorder or vitamin deficiency?
  • Is the individual on anticoagulant therapy?
  • Does the individual complain of pain, swelling, discoloration of the eyelid and blurred or double vision?
  • On exam, what was the extent of the injury?
  • Is there bleeding in the eye?
  • Did the individual have visual acuity and range of eye motion testing?
  • Did the individual have x-rays?
  • Have conditions with similar symptoms been ruled out?

Regarding treatment:

  • Was prompt treatment initiated?
  • Was the individual treated by cleansing the area and applying an ice pack?
  • Did the individual switch to hot compresses after 24 hours of ice?
  • Is the individual sleeping with the head elevated? Wearing sunglasses?
  • Were analgesics, antibiotics, or pupil dilation prescribed?

Regarding prognosis:

  • Is the individual's employer able to accommodate any necessary restrictions?
  • Does the individual have any condition that may affect the ability to recover?
  • Does the individual have any complications such as subconjunctival hemorrhage, hyphema, glaucoma, damage to the iris, vitreous hemorrhage, bleeding and swelling of the retina, retinal detachment, fracture of the eye socket, optic nerve injury, cataract, infection, or permanent loss of vision?
  • Does the individual have any ossification?

Source: Medical Disability Advisor



References

Cited

"Eye Trauma: Epidemiology and Prevention." USEIR Online. 2000. United States Eye Injury Registry. 22 Oct. 2004 <http://www.useironline.org/Prevention.htm>.

Source: Medical Disability Advisor






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