Eye Trauma

Ophthalmologic Emergencies

Chemical Burns

1. Immediately irrigate the eye with lots of water
   • If over the phone, tell the parent to continuously flush the eye
   • If the patient is at the office and you are unable to open the lids
     • Placing a topical anesthetic will allow you to open the eyes and flush
   • Irrigate for about 20 minutes and have patient change gaze to allow total eye to be flushed
   • May need to pick out particulate matter
2. Check visual acuity
3. Check pH of eyes (normal physiological range pH 7.0-7.3)
   • After a chemical burn, thorough eye washing for at least 30 minutes or until the pH of the eye is within physiologic range is critical to prevent further damage.
4. Check for any corneal changes by staining with Fluorescein drops
   • If there is an abrasion administer antibiotics, cycloplegics, and patch
5. Refer to ophthalmologist if
   • Decreased acuity
   • Burn was with alkali or acid
   • Severe conjunctival swelling
   • Corneal changes

Trauma

1. Hyphemas are blood in the anterior chamber, will see blood layering
   • May be associated with global injury
     • About 30% will rebleed leading to acute increase in intraocular pressure
   • Should refer to ophthalmologist immediately for therapy
   • Decrease activity and have frequent examinations
   • Often need to sedate patient
   • Eye shield is used
2. Complicated lid lacerations require ophthalmologist
3. See also Eye Penetration

Intraocular Foreign Body

1. There may be minimal symptoms
2. Patient's activity at time of accident most important
   • Often working with drilling or hammering and sudden impact feeling
3. Check visual acuity
4. Consider CT or Ultrasound (sensitivity less than CT)
5. Check for laceration of the globe, hyphema, pupil changes
6. Refer to ophthalmologist

Corneal Foreign Body

1. See also Corneal Abrasion
2. There is a foreign body sensation
3. Increased tearing, conjunctivitis, and light sensitivity
4. If the onset of symptoms is gradual, suspect keratitis of infectious etiology
   • Often associated with wearing contacts or viruses

Conjunctival Foreign Body

1. May see under the lid, usually tarsal
2. To see may put topical anesthetic in eye
3. Using cotton applicator, roll the lid over the applicator and then try to scrape with the cotton applicator
   • May use side of 25 gauge needle to remove
   • Should also check for corneal abrasion

See also Corneal Abrasion, Corneal Ulcer

Proptosis

1. Forward displacement of the globe due to increased soft tissue or bone
2. Can be a result of
   • Grave's disease
   • Tumor
   • Inflammation-orbital cellulitis
3. Urgent referral if
   • Unilateral
   • Acute
   • Painful
   • Motility changes
   • Decreased acuity

See also Periorbital and Orbital Cellulitis

References

1. Pokhrel PK, Loftus SA. Ocular Emergencies. Am Fam Physician, Sept 15, 2007;6(6):829-836
2. Khare GD, Symons CA, Do DV. Common Ophthalmic Emergencies. Int Journ Clin Pract, 2008;62(11):1776-1784
3. Tingley DH. Consultation with the Specialist: Eye Trauma: Corneal Abrasions. Pediatrics in Review. 1999; 20:320-322.
4. Hoffman Robert. Evaluating and Treating Eye Injuries. Contemporary Pediatrics. April 1997.
5. Wilson S. Last A. Management of Corneal Abrasions. American Family Physician July 1, 2004.

Contributor(s)

1. Ballarin, Daniel, MD

Updated/Reviewed: February 2015