From the Guidelines
The initial management of eye trauma involves seeking immediate medical attention for high-velocity injuries, penetrating injuries, or symptoms such as eye bleeding, loss of vision, or persistent foreign-body sensation, as recommended by the 2024 American Heart Association and American Red Cross guidelines for first aid 1. When managing eye trauma, it is crucial to prioritize protection and assessment to prevent further damage.
- Avoid touching, rubbing, or applying pressure to the injured eye.
- If a foreign body is visible on the surface, gently flush with clean water or saline solution, but never attempt to remove embedded objects, as this can cause further injury.
- For chemical exposures, irrigate continuously with water for at least 15-20 minutes to help neutralize the chemical and reduce the risk of severe damage.
- Apply a rigid eye shield (not a patch) for penetrating injuries or if the globe appears ruptured to protect the eye from further trauma.
- Administer pain relief as needed, such as acetaminophen 650-1000mg or ibuprofen 400-600mg every 6 hours, to help manage discomfort and reduce agitation that could exacerbate the injury.
- Urgent ophthalmologic evaluation is essential for all significant eye injuries, as even seemingly minor eye injuries can lead to vision loss if improperly managed, highlighting the importance of prompt medical attention 1. While waiting for professional care, keep the patient in an upright position to reduce intraocular pressure, advise against eating or drinking in case emergency surgery is needed, and administer antiemetics if necessary to prevent vomiting which could increase intraocular pressure. This approach, based on the latest guidelines 1, protects the eye from additional trauma while preparing for definitive treatment, emphasizing the critical role of immediate and appropriate first aid in preserving vision and reducing morbidity.
From the Research
Initial Management of Eye Trauma
The initial management of eye trauma involves several key steps to ensure proper care and prevent further injury.
- Addressing any life-threatening conditions is the first step in managing eye trauma 2.
- A focused history and exam is then conducted, starting externally, to assess the extent of the injury 2.
- Key history, physical, pathophysiology, and basic management of common, serious eye injuries such as chemical injury, orbital fractures, open globe, traumatic hyphema, retinal detachment, traumatic optic neuropathy, and eyelid laceration are crucial in the initial management of eye trauma 2, 3.
Assessment and Examination
A detailed history followed by a complete ocular and, if indicated, radiological examination is a crucial part of any trauma assessment 3.
- Determining whether a patient with ocular trauma can be reassured or requires immediate referral for further investigation and surgical repair is essential 3.
- A structured approach to the history and examination is provided to enhance clinician confidence when encountering patients with ocular trauma 3.
Types of Ocular Trauma
Ocular trauma can result in various types of injuries, including:
- Chemical eye injuries
- Orbital fractures
- Superficial corneal foreign bodies
- Closed globe injury
- Suspected open globe injury with or without intra-ocular foreign bodies 3
- Penetrating eye injuries, which can be unintentional, the result of assault, or self-inflicted 4
Importance of Timely Treatment
Accurate history-taking and astute observation are paramount for timely treatment or referral that may prevent blindness 3.
- The identification of a need for immediate treatment should be implemented in the algorithm of an emergency room, especially in a head and neck trauma center, to reduce the risk of a devastating loss of vision 5.