Treatment of Eye Trauma
The appropriate treatment for eye trauma depends on the type and severity of injury, with immediate medical attention required for high-velocity injuries, penetrating injuries, irregular pupils, eye bleeding, or vision loss after trauma. 1
Initial Assessment and First Aid
- Do not rub the eye if there is a foreign-body sensation, as this can worsen the injury 1
- Tape a hard plastic eye shield, paper cup, or plastic cup over the injured eye to prevent unintentional touching 1
- For foreign bodies from low-energy mechanisms (dust, dirt, wind-blown objects), allow natural tears to wash out the object or irrigate with tap water or commercial eye wash solution 1
- For chemical eye injuries, immediate irrigation with copious amounts of tap water for 15 minutes should be performed 1
- When irrigating chemical eye injuries, avoid contaminating the other eye, other individuals, or other areas with the caustic substance 1
Triage and Referral Guidelines
Immediate Medical Attention Required For:
- High-velocity eye injuries (grinding, nailing, machinery) 1
- Penetrating eye injuries from sharp or metal objects 1
- Irregular pupil after trauma 1
- Eye bleeding after trauma 1
- Loss of vision after trauma 1
- Persistent foreign-body sensation 1
- Entrapped muscle or periorbital tissue with oculocardiac reflex (bradycardia, heart block, dizziness, nausea, vomiting) 1
- Globe subluxation into the maxillary sinus 1
- White-eyed blow-out fracture with muscle entrapment 1
Treatment Based on Injury Type
Foreign Body in Eye
- For superficial foreign bodies: irrigation with tap water or commercial eye wash 1
- Over-the-counter oral acetaminophen or NSAIDs for residual discomfort after removal 1
- For contact lens-related foreign body sensation: remove the lens, discontinue use, and seek medical attention 1
Chemical Eye Injuries
- Immediate irrigation with copious amounts of tap water for 15 minutes 1
- Eye irrigation with normal saline, Ringer's lactate solution, or commercial eye wash solution if immediately available 1
- For industrial chemical exposures, follow local guidelines or recommendations from a poison center 1
Orbital Fractures
- Timing of repair depends on specific findings:
- Immediate repair for entrapped muscle with oculocardiac reflex or globe subluxation 1
- Repair within 1-2 weeks for symptomatic diplopia with positive forced ductions, large floor fractures, hypoglobus, or early enophthalmos causing facial asymmetry 1
- Delayed repair (after 2 weeks) may benefit restrictive strabismus and unresolved enophthalmos 1
- Observation for minimal diplopia with good ocular motility without significant enophthalmos 1
Corneal Ulcers (if diagnosed)
- Ciprofloxacin ophthalmic solution 0.3%: two drops every 15 minutes for first six hours, then two drops every 30 minutes for remainder of first day, hourly on second day, and every four hours on days 3-14 2
Post-Trauma Management
For Strabismus After Orbital Trauma
- Some forms will improve with time; watchful waiting is often reasonable 1
- A short burst of oral steroids can hasten recovery 1
- Conservative treatment options include occlusion, filters, Fresnel prisms, botulinum toxin injection, and prism glasses 1
- For persistent strabismus, wait 4-6 months after injury before surgical intervention unless there is substantial fat and orbital pulley entrapment 1
Common Pitfalls to Avoid
- Failing to recognize high-velocity injuries that require immediate attention 1
- Rubbing the eye when there is a foreign body sensation 1
- Inadequate irrigation of chemical injuries 1
- Missing signs of oculocardiac reflex, which can be life-threatening 1
- Delaying treatment for orbital fractures with muscle entrapment 1
- Overlooking potential damage to the angle, lens, macula, and peripheral retina that can have long-term visual consequences 3
Remember that eye injuries are a common cause of noncongenital monocular blindness, and proper management is essential to preserve vision 4. Even seemingly minor trauma can harbor severe injuries in the recesses of the angle or far periphery of the retina 3.