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

 

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.