From the Guidelines
The management of a knife stab wound under the eye requires immediate emergency medical attention, with a focus on controlling bleeding, preventing infection, and assessing for potential damage to critical structures such as the eye, facial nerves, and sinuses. The first step is to call 911 or go to the nearest emergency department, as this is a potentially life-threatening injury. While awaiting professional help, apply gentle pressure with a clean cloth to control bleeding, but be extremely careful not to press on any embedded objects or the eye itself. Do not remove any impaled objects as this could cause further damage or increased bleeding.
In the hospital, management will typically include:
- Wound cleaning with sterile normal saline, as recommended by 1
- Tetanus prophylaxis, to prevent tetanus infection, especially if the patient's tetanus prophylaxis status is outdated or unknown, as suggested by 1
- Possible antibiotics to prevent infection, particularly in high-risk cases or if there are signs of infection, although universal prophylaxis with antibiotics is not recommended, as stated by 1
- Imaging studies like CT scans to assess for deeper injuries, such as damage to the orbit, optic nerve, or penetration into the brain
- Surgical repair by specialists such as ophthalmologists, plastic surgeons, or maxillofacial surgeons, depending on the extent and depth of the injury
Pain management will be provided, and depending on the depth and extent of injury, the patient may need to be monitored for complications like vision changes, cerebrospinal fluid leakage, or infection. The proximity of the wound to critical structures makes professional medical evaluation absolutely essential, as emphasized by the need for careful management to prevent morbidity, mortality, and to maintain quality of life, as considered in 1 and 1.
From the Research
Management of Knife Stab Wound Under the Eye
The management of a knife stab wound under the eye is crucial to prevent significant harm to the optic nerves, eyeball, brain, and cerebral vessels. The following steps are recommended:
- Prompt recognition of the extent of the injury 2
- Broad-spectrum parenteral antibiotics to prevent infection 2
- Tetanus prophylaxis to prevent tetanus infection 2
- Anticonvulsant medication to prevent seizures 2
- Early surgical intervention under direct vision to remove the foreign body and avoid immediate and long-term complications 2, 3, 4
Surgical Intervention
Surgical intervention is necessary to remove the foreign body and explore adjacent cerebral structures 2, 3, 4. The surgery should be performed under general anesthesia, and the patient should be closely monitored for any neurological deficits or complications 5. The operation team should be ready for urgent exploration in case of any complications 5.
Postoperative Care
After surgery, the patient should be closely monitored for any signs of infection, cerebrospinal fluid leakage, or neurological deficits 5, 4. Long-term follow-up is essential to detect any late complications such as infection or pseudomeningocele development 5.
Importance of Protective Measures
It is essential to implement protective measures consistently to avoid eye injuries, especially in children 6. Particular attention should be paid to safety, and the possible consequences of certain activities should be considered 6.
Treatment Algorithm
A proposed treatment algorithm for stab wounds to the head includes a contrast-enhanced computed tomography scan of the skull and brain, and a brain vascular study, considering the location of the knife in the skull and brain 4. Surgery accompanied by antibiotic therapy is the best treatment protocol 4.