Eye Trauma

Remember

Wounds require tetanus prophylaxis and broad spectrum antibiotic if significant risk of contamination, or debridement of necrotic tissue.

History

• Likely foreign body
• Which eye
• Mechanism
  • Velocity
• Protective eye wear?
• Previous eye trauma – reduced structural integrity
• When did it happen?
• Contact lens wearer
• What are the symptoms?
  • Photophobia
  • Discharge and type

Blunt trauma

• Types
  • Closed globe injury
  • Ruptured globe
• Signs
  • Haemorrhage
    • Hyphaema
    • Vitreous
    • Retina → retinal detachment
  • Vision changes
    • Iris damage
    • Lens damaged or dislocated
    • Angle of eye drainage damage
• Investigate: CT scan for orbital wall fracture
• Management: Topical antibiotics and suture eye lid lacerations and urgent referral

Penetrating trauma

• Prolapse of the intraocular contents and irreversible damage can occur
• Signs:
  • Distorted pupil
  • Cataract
  • Prolapsed black uveal tissue on the ocular surface
  • Vitreous haemorrhage
• Dilate pupil and search for intraocular foreign body
  • Radiograph with eye in up and down gaze
  • Apply shield and transfer to eye department
• All penetrating eye injuries need immediate referral
• Management:
  • Nil by mouth
  • Strict bed rest
  • Analgesia/antiemetic
  • CT
  • Shield (not pad)
  • Tetanus status
  • Broad spectrum antibiotics

Corneal foreign body

• Any foreign body penetration of the cornea or retained foreign body will require urgent referral to ophthalmologist – immediate consult by phone
• Management removing corneal foreign body
  • Topical anaesthetic
  • Slit lamp and remove body
    • Cotton bud
    • Fine needle
    • Motorised dental burr
  • Use fluorescein to assess and measure the size of epithelial defect
  • Topical antibiotics and cycloplegic agent
  • Refer to ophthalmologist if body not removed and symptoms worsen

Chemical Burns Management

• Instil local anaesthetic drops to affected eye/eyes.
• Commence irrigation with 1 litre of a neutral solution, eg N/Saline (0.9%), Hartmann’s.
• Evert the eyelid and clear the eye of any debris / foreign body that may be present by sweeping the conjunctival fornices with a moistened cotton bud.
• Continue to irrigate, aiming for a continuous irrigation with giving set regulator fully open.
  • If using a Morgan Lens, carefully insert the device now.
• Review the patient’s pain level every 10 minutes and instil another drop of local anaesthetic as required.
• After one litre of irrigation, review.
  • If using a Morgan Lens, remove the device prior to review.
• Wait 5 minutes after ceasing the irrigation luid then check pH. Acceptable pH range 6.5-8.5.
• Consult with the senior medical oficer and recommence irrigation if necessary.
• Severe burns will usually require continuous irrigation for at least 30 minutes
• Immediate referral