Eye Injuries / Complaints

 

History:

 

  • Time of injury/onset
  • Blunt/penetrating/chemical
  • Open vs. closed injury
  • Wound contamination
  • Medical history
  • Medications
  • Tetanus history
  • Involved chemicals
  • Material safety data sheet (MSDS)

 

Significant Findings:

 

  • Pain
  • Swelling/bleeding
  • Deformity/contusion
  • Visual deficit
  • Leaking aqueous/vitreous humor
  • Upwardly fixed eye
  • "Shooting" or "streaking" light
  • Visible contaminants
  • Rust ring

 

Differential:

 

  • Abrasion/laceration
  • Globe rupture
  • Retinal nerve damage/detachment
  • Chemical/thermal burn/agent of terror
  • Orbital fracture
  • Orbital compartment syndrome
  • Neurological event
  • Acute glaucoma

 

Treatment:

 

 

 

  • Oxygen

 

 

 

  • Initiate IV

 

Pain/visual disturbance ?

 

  • Yes

 

 

 

    • Assess visual acuity
    • Evaluate pupils
    • Complete neuro exam
    • Screen for unrecognized chemical/agent exposure
    • Cover both eyes

 

 

 

 

Injury isolated to eye(s) ?

 

  • No

 

    • See appropriate protocol

 

  • Yes

 

Out of socket ?

 

  • Yes

 

 

 

    • Cover with saline moistened gauze
    • Cover unaffected eye

 

 

 

 

In socket ?

 

  • Yes

 

Trauma ?

 

  • Yes

 

 

 

  • Assess orbital stability
  • Assess visual acuity (when feasible)
  • Cover both eyes

 

 

 

 

Burn/chemical ?

 

  • Yes

 

 

 

  • Immediate irrigation with available Normal Saline or water

 

 

 

  • Tetracaine 2 gtt (when available)
  • Irrigate with Normal Saline using Morgan Lens
  • Cover unaffected eye

 

 

 

 

PEARLS:

 

  • Normal visual acuity can be present even with severe eye injury.
  • Remove contact lens whenever possible.
  • Any chemical or thermal burn to the face/eyes should raise suspicion of respiratory insult.
  • Orbital fractures raise concern of globe or nerve injury and need repeated assessments of visual status.
  • Always cover both eyes to prevent further injury.
  • Use shields, not pads, for physical trauma to eyes. Pads are okay for unaffected eye.
  • Do not remove impaled objects.

NREMR

National Registry Emergency Medical Responder

NREMT-I

National Registry EMT-Intermediate

NREMT

National Registry Emergency Medical Technician

NRP

National Registry Paramedic

NRP

National Registry Paramedic

NREMT

National Registry Emergency Medical Technician

NREMT

National Registry Emergency Medical Technician

NRP

National Registry Paramedic

NREMT

National Registry Emergency Medical Technician

NRP

National Registry Paramedic

Sheriffs Office