Treatment of Eye Trauma
For eye trauma, immediate irrigation with copious amounts of tap water for at least 15 minutes is recommended for chemical injuries, while other types of eye trauma require specific management based on the mechanism and severity of injury. 1
Initial Assessment and First Aid
- Immediate medical attention is required for high-velocity eye injuries, penetrating injuries, irregular pupils, eye bleeding, or vision loss after trauma 1
- For chemical eye injuries, immediately irrigate with copious amounts of tap water for at least 15 minutes 2, 1
- If tap water is not available, normal saline or commercial eye irrigation solution may be used 2
- When irrigating chemical eye injuries, avoid contaminating the unaffected eye or other areas with the caustic substance 1
- For superficial foreign bodies from low-energy mechanisms, allow natural tears to wash out the object or irrigate with tap water or commercial eye wash solution 1
- Control external bleeding by applying direct pressure to the bleeding site 2
Triage and Referral Guidelines
- Seek immediate medical attention for:
- High-velocity eye injuries 1
- Penetrating eye injuries 1
- Irregular pupils 1
- Eye bleeding 1
- Vision loss after trauma 1
- Persistent foreign-body sensation 1
- Entrapped muscle or periorbital tissue with oculocardiac reflex 1
- Globe subluxation into the maxillary sinus 1
- White-eyed blow-out fracture with muscle entrapment 1
Treatment Based on Injury Type
Chemical Injuries
- Immediate irrigation with copious amounts of tap water for 15 minutes 2, 1
- Contact local poison control center or seek medical help 2
- Follow-up with eye irrigation using normal saline, Ringer's lactate solution, or commercial eye wash solution if available 1
Foreign Bodies
- For superficial foreign bodies, irrigation with tap water or commercial eye wash 1
- Over-the-counter oral acetaminophen or NSAIDs for residual discomfort after foreign body removal 1
- Avoid rubbing the eye when there is a foreign body sensation as this can worsen the injury 1
Blunt Trauma
- Daily ophthalmological review is necessary during acute illness to monitor for complications 3
- Apply ocular lubricants (e.g., nonpreserved hyaluronate or carmellose eye drops) every 2 hours to protect the corneal surface 3
- Administer topical pressure-lowering therapies if intraocular pressure is elevated 3
- Local cold therapy, such as an instant cold pack, can be useful for injuries to the extremity or scalp, but should be used with caution in children due to risk of hypothermia 2
Orbital Fractures
- Timing of repair depends on specific findings 1
- Immediate repair is recommended for entrapped muscle with oculocardiac reflex or globe subluxation 1
Post-Trauma Management
- Watchful waiting is often reasonable for strabismus after orbital trauma 1
- A short burst of oral steroids can hasten recovery of strabismus 1
- Conservative treatment options for strabismus include occlusion, filters, Fresnel prisms, botulinum toxin injection, and prism glasses 1
- Surgical intervention for persistent strabismus is typically delayed for 4-6 months after injury, unless there is substantial fat and orbital pulley entrapment 1, 3
- Thorough examination of both eyes is essential, as less severe trauma may have resulted in serious injuries that can go undetected 4
Common Pitfalls to Avoid
- Failing to recognize high-velocity injuries that require immediate attention 1
- Inadequate irrigation of chemical injuries leading to long-term visual consequences 1
- Missing signs of oculocardiac reflex, which can be life-threatening 1
- Delaying treatment for orbital fractures with muscle entrapment 1
- Overlooking potential severe injuries in the angle or far periphery of the retina 4
- Neglecting to examine the fellow eye in cases of blunt trauma 4
- Failing to provide early treatment for retinal tears and elevated intraocular pressure, which can help prevent potentially severe vision loss 4