TRAUMATIC CONDITIONS OF THE EYE416 Ophthalmic Emergencies
(i) Ideally, pad both eyes and give appropriate analgesia.
(ii) Protect a suspected ruptured globe with an eye shield, not an eye
pad.Penetrating trauma to the eye
DIAGNOSIS AND MANAGEMENT
1 Penet rat i ng t rau ma is u su a l ly obv iou s , a lt houg h on occ a sions it may be d i f f i-
cult to recognize initially and must be thought of after a high-velocity injury
mechanism such as drilling or mowing.
2 Look for the following injuries:
(i) Corneal laceration, often with prolapse of the iris into the defect.
(ii) Scleral perforation with chemosis or bulging local haemorrhage.
This must be differentiated from a trivial subconjunctival bleed.
(iii) Collapse of the anterior chamber, hyphaema or vitreous
haemorrhage, pupil irregularity and lens dislocation.
3 Intraocular foreign body:
(i) This is usually a metal fragment from using a hammer and chisel,
metal drill or grinding wheel.
(ii) Sudden sharp pain is followed by localized redness, or the outside
of the eye may appear deceptively normal and the incident
forgotten.
(iii) Examine carefully for a puncture wound, and use an
ophthalmoscope to inspect the inner eye, although a traumatic
cataract may preclude this.
(iv) X-ray the orbit if there is the remotest possibility of penetration.
Request two soft-tissue films, with the eye looking up and down,
to identify a radiodense intraocular foreign body
(a) request a CT of the orbit if the X-ray is negative, but
suspicion remains high.
4 Instil antibiotic eye drops (not ointment), protect the eye from further
damage with an eye shield, and give tetanus prophylaxis.
(i) Provide analgesia if required, e.g. morphine 5 mg i.v. with an
antiemetic such as metoclopramide 10 mg i.v.
(ii) Give gentamicin 5 mg/kg i.v. plus ceftriaxone or cefotaxime
1 g i.v.
5 Refer all cases of documented penetrating injury to the eye and actual
or suspected intraocular foreign body immediately to the ophthalmology
team.