Traumatic injuries to the eye are the leading cause of visual impairment and blindness in people under the age of 46. 25% of all traumatic eye injuries occur in children and adolescents aged 0-18 years, while almost 50% occur in 18–45 year-olds. Injuries may be significant despite having a benign appearance.
In the prehospital setting the most important management principal is to protect the eye from further injury and avoid secondary injury from increased intraocular pressure during transport to an appropriate hospital.
Eye injuries have the potential to be significant, despite normal vision and minor pain.
General Symptoms:
- Pain
- Redness
- Tears
- Impaired vision
- Photophobia
- Haemorrhage
- Fluid loss from the eye
Arc eyes / Welders Flash
- History of poorly protected/ unprotected exposure to a high intensity light source
- Delay in onset of pain, typically several hours
- Redness of eyes with photophobia
- Typically complains of the sensation of foreign body
Blunt Eye Injury
Orbital bony wall is relatively thin thus susceptible to fracture from transfer of mechanical energy across globe. Potential injuries include:
- Hyphaemia
- Iridodialysis
- Orbital blow-out fracture
- Retinal detachment
- Retrobulbar haemorrhage
- Ruptured Globe
Hyphaemia
Iridodialysis
Orbital blow-out fracture
Retinal detachment
Retrobulbar haemorrhage
Ruptured Globe
Retinal Detachment
- Either as consequence of traumatic or non-traumatic aetiology.
- Presence of floating specks, colloquially termed floaters
- Flashes of light in one or both eyes
- Curtain like shadow over the visual field
Penetrating Eye Injury
- Abnormally shaped or collapsed globe
- Loss of vision
- Squashed or distorted appearance of globe
- Ocular contents protruding from globe (iris and retina, vitreous)
- Laceration
- Prolapsed tissue
- Hyphaemia
- Relative afferent pupil defect
- Chemosis (bulging of the conjunctiva)
Chemical Injury
- Injury relates to the PH of the chemical involved.
- Alkali chemicals cause rapid and deep eye injuries from liquefactive necrosis
- Acids can cause significant eye injury but are typically less severe
- Severe pain with most chemicals
- Blurred vision/ loss of vision
- Redness
- Nausea associated with analgesia increases the risk of raised intraocular pressure. Prophylactic Ondansetron administration is recommended to avoid secondary injury
- Eye injuries associated with major trauma should go to a Major Trauma Centre as per the Major Trauma Guidelines
- Avoid manipulating the eye as it may result in intraocular pressure (ie. Eye lid retraction)
- With penetrating injuries, manipulation may result in extrusion of intraocular contents or rupture of the globe
- Dependant on nature of the injury, patients require theater management. Fast as needed
- Primary Survey with c-spine consideration
- Be aware of Trauma Management Principles
- Manage catastrophic bleeding (with haemorrhage control as required)
- For penetrating eye injury:
- Do not remove any penetrating foreign body from globe. If tolerated, place raised protective eye shield over affected eye
- Do not remove any penetrating foreign body from globe. If tolerated, place raised protective eye shield over affected eye
- For chemical burns:
- Irrigate with normal saline as early as possible for a minimum of 30 minutes.
- For lid lacerations:
- If required to control bleeding, place direct pressure around eye, avoiding pressure to the globe.
- Position patient supine with 30° head elevation to reduce intra-ocular pressure.
- Secondary / CNS Survey
- Administer Ondansetron
- Administer pain relief
- Monitor patient persistently, recording full observations every 10 minutes (or 5 minutes if time critical)
- Transport Priority 1 if the patient is time critical, pre-notifying the receiving facility
- Administer Ondansetron
- Administer pain relief
- Monitor patient persistently, recording full observations every 10 minutes (or 5 minutes if time critical)
- Transport Priority 1 if the patient is time critical, pre-notifying the receiving facility
- As per Advanced Care guidelines
Additional Information
| Settings | |
|---|---|
| Extended Care: | |
| Colour assist: | |
Hyphema - StatPearls - NCBI Bookshelf (nih.gov)
Retrobulbar-Haemorrhage-Clinical-Practice-Guideline.pdf (eyeandear.org.au)
What Is an Orbital Fracture? - American Academy of Ophthalmology (aao.org)
Atlas Entry - Traumatic cataract with iridodialysis and lens coloboma (uiowa.edu)
Traumatic Iridodialysis | Vagelos College of Physicians and Surgeons (columbia.edu)
Retinal Detachment | National Eye Institute (nih.gov)
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