TRAUMATIC CONDITIONS OF THE EYE414 Ophthalmic Emergencies
6 Always remember the possibility of intraocular penetration, with any high
velocity injury, e.g. by a metal fragment from drilling or hammering, or a
stone from mowing (see p. 416).Corneal foreign body
DIAGNOSIS AND MANAGEMENT
1 The foreign body may be obvious, or revealed by f luorescein staining.
2 Instil local anaesthetic drops and attempt removal of the foreign body with a
moistened cotton-wool bud or the bevel of a hypodermic needle, introduced
from the side.
3 However, leave deep or recalcitrant foreign bodies, and those with an exten-
sive rust ring a lone.
(i) Refer the patient to the ophthalmology team to avoid causing
further damage during attempted removal.
4 As local anaesthetic was used, pad the eye for 1–2 h until the return of normal
sensation. Treat any corneal epithelial defect demonstrated on f luorescein
staining as for a corneal abrasion (see below).
5 Review the patient within 2 days to exclude infection, but ask them to return
earlier if pain increases or vision deteriorates.
(i) Refer the patient immediately to the ophthalmology team if there
is then evidence of an infected corneal ulcer.Corneal abrasion
DIAGNOSIS AND MANAGEMENT
1 Corneal abrasion is due to a foreign body or to direct injury from a finger,
stick or a piece of paper.
2 There is intense pain, watering and blepharospasm. Local anaesthetic drops
may be needed before the eye can be opened properly.
3 Use f luorescein staining to reveal the damage.
4 Give the patient 0.5% chloramphenicol eye drops and cycloplegic drops, and
review within 2 days.
5 An eye pad is not needed, other than for 1–2 h following local anaesthetic use.
6 The cornea should be fully recovered by 2 days, so refer the patient to the
ophthalmology team if there is delayed healing or a recurrence.Flash burn (arc eye)
DIAGNOSIS AND MANAGEMENT
1 Exposure to ultraviolet light from welding without using protective goggles,
or from a sun lamp, causes a superficial keratitis.