Special Operations Forces Medical Handbook

3-27

meningitis.

Plan:

Treatment

1. Preseptal cellulitis: levofloxacin 500 mg po once a day, expedite evacuation if no improvement in 24-48
   hours.


2. Dacryocystitis: as for preseptal cellulitis above. Use warm compresses on the inflamed eye.


3. Periocular insect envenomation: cool compresses and antihistamines; levofloxacin 500 mg po once a day
   if secondary infection is suspected based on increasing pain, redness, or swelling.


4. Orbital cellulitis: life-threatening disorder requiring emergent evacuation, levofloxacin 500 po mg bid and
   decongestants.

Patient Education
General: Discuss severity of the condition with the patient
Activity: Limited with IV antibiotics.
Diet: Regular as tolerated
Prevention: Good personal hygiene
Wound Care: Warm or cool compresses, depending on diagnosis.

Follow-up Actions
Return Evaluation: Return every 12 to 24 hours.
Evacuation/Consultation Criteria: Immediate evacuation for acute proptosis and/or decreased eye motility.

Symptom: Eye Problems: Eye Injury

MAJ Thomas Lovas, MC, USA & CAPT Frank Butler, MC, USN

Subjective: Symptoms
Eye pain, loss of vision, foreign-body sensation (especially in chemical injuries), increased sensitivity to light or
photophobia (irritation of cornea or iris), nausea and vomiting (if the intraocular pressure rises suddenly).
Focused History: Did something hit you in the eye? (typical exposure) What were you doing when the
injury occurred? (exposure) Were you wearing glasses and/or safety glasses? If so, are there any broken
fragments, etc? (look for “missing pieces” which may have become intraocular foreign bodies) Were you (or
someone near you) hammering metal-on-metal? (foreign bodies; i.e., initial pain as the high speed foreign
body enters the eye, then resolution of symptoms over a brief period of time) What type of chemicals were
you using (in the case of chemical injury)? (exposure) Did you or someone else flush your eyes? (can
decrease extent of injury) Are you sickle cell positive? (can have significant impact on intraocular bleeding
after trauma)

Objective: Signs
Using Basic Tools: Do not palpate potentially ruptured globe! obvious wound (including lid laceration),
decreased visual acuity, possible ruptured globe, conjunctivitis, extra-ocular muscle derangement, non-circular
(irregular) pupil, deviated (disconjugate) gaze, eye drainage, photophobia; tangential light exam may reveal
blood in anterior chamber (hypema), corneal ulcer (white or gray spot).
Using Advanced Tools: Ophthalmoscope: retinal (red) reflex, blood in anterior (hyphema) or posterior
chamber, visible foreign body; fluorescein strips (only if globe intact), ophthalmic anesthetic (1 drop) if
available and UV light: look for corneal abrasion or ulcer.

Assessment:
Differential Diagnosis
Hyphema - blood seen in anterior chamber
Orbital fracture - detected by extra-ocular muscle derangement or new onset gaze derangement