From the Research
For a stab wound to the eye, immediate management involves protecting the eye from further damage by placing a rigid shield over the eye without applying pressure, as emphasized in the most recent study 1. The goal of this initial step is to prevent any additional injury that could exacerbate the condition. Key considerations in the management of such injuries include:
- Not attempting to remove any impaled objects, as this could lead to further complications, including increased bleeding or damage to the eye structures, a principle supported by various studies including 2 and 3.
- Administering pain medication as needed, such as IV morphine or fentanyl, to ensure the patient's comfort and reduce pain, which is crucial for preventing unnecessary stress and potential complications.
- Starting broad-spectrum antibiotics immediately to prevent infection, typically with a combination of topical and systemic antibiotics like moxifloxacin eye drops, ceftriaxone, and vancomycin, as infection can lead to severe consequences including vision loss.
- Ensuring tetanus prophylaxis is up to date or administering it if the status is unknown or outdated, to prevent tetanus infection.
- Obtaining urgent ophthalmology consultation for definitive management, as penetrating eye injuries are true emergencies that require prompt and specialized care.
- Considering a CT scan of the orbit and head to assess the extent of the injury, especially if there are concerns about the depth of the wound or potential involvement of other structures.
- Advising the patient to avoid straining, coughing, or bending over to prevent increased intraocular pressure, which could worsen the injury.
The management of penetrating eye trauma, such as a stab wound, is critical and time-sensitive. The most recent and highest quality study 1 underscores the importance of a structured approach to history and examination, highlighting the need for detailed assessment and timely referral for further investigation and surgical repair if necessary. Given the potential for serious sight- and eye-threatening consequences, accurate history-taking and astute observation are paramount for timely treatment or referral that may prevent blindness. In the context of real-life clinical medicine, prioritizing the patient's safety and the preservation of visual function is paramount, and thus, following the guidelines outlined, with a focus on immediate protection of the eye, prevention of infection, and urgent specialist consultation, is crucial for optimizing outcomes in cases of penetrating eye trauma.