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
• Retinal artery occlusion

 

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

• • Pain Control: See Pain Control Protocol

 

Injury isolated to eye(s) ?

 

• No

 

• • See appropriate protocol

 

• Yes

 

Out of socket ?

 

• Yes

 

• • Cover with saline moistened gauze

• • Cover unaffected eye
  • Pain Control: See Pain Control Protocol

 

In socket ?

 

• Yes

 

Trauma ?

 

• Yes

 

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

• • Pain Control: See Pain Control Protocol

 

Burn/chemical ?

 

• Yes

 

• • Immediate irrigation with available Normal Saline or water
  • Tetracaine 2 gtt (when available) (Special Operations)

• • Irrigate with Normal Saline using Morgan Lens (Special Operations)
  • Cover unaffected eye

• • Pain Control: See Pain Control Protocol

 

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.
• Suspected globe rupture or compartment syndromes require emergent in-facility intervention
• Patient should be placed in fowlers position with any suspected globe injury.