Emergency Medicine

TRAUMATIC CONDITIONS OF THE EYE

412 Ophthalmic Emergencies

2 Traumatic

(i) This may be due to a surface conjunctival foreign body, or a

more serious penetrating foreign body and or bulging scleral

perforation

(a) gentle digital assessment may reveal reduced eyeball tone in

penetration of the globe.

(ii) Refer all patients immediately to the ophthalmology team if a

serious cause is suspected.

(iii) Consider a basal skull fracture when the posterior margin of the

haematoma cannot be seen

(a) arrange a computed tomography (CT) head scan and refer

the patient to the neurosurgical team (see p. 31).

(iv) Otherwise, minor cases require reassurance only.

Eyelid laceration

DIAGNOSIS AND MANAGEMENT

1 Refer the patient directly to the ophthalmology or plastic surgery team if the

laceration involves the tarsal plate, upper eyelid, lid margin or the medial

canthus and the lacrimal apparatus.

2 Otherwise, suture the eyelid under local anaesthesia using fine 6/0

non-absorbable monofilament nylon or polypropylene sutures. Remove

after 4 days.

Eyelid burn

DIAGNOSIS AND MANAGEMENT

1 Examine the eye carefully for evidence of corneal or scleral damage before

oedema makes the examination impossible, although the blink ref lex usually

protects the globe.

2 Give the patient antibiotic drops, analgesia and tetanus prophylaxis, and

refer immediately to the ophthalmology team.

Chemical burns to the eye

DIAGNOSIS AND MANAGEMENT

1 Alkalis are more deeply penetrating and dangerous than acids, and include

common agents such as cement, plaster powder, and oven or drain cleaners.

2 The mainstay of treatment is immediate, copious, prolonged irrigation (up

to 30 min) with normal saline from an i.v. giving set. Instil local anaesthetic

drops to open the eye initially.

3 Give additional analgesia if necessary with morphine 5 mg i.v. plus an

antiemetic such as metoclopramide 10 mg i.v.