7-29
Objective: Signs
Using Basic Tools: Loss of visual acuity-assess with newsprint, or if available, a Snellen Chart or Vision
Screener. Loss of visual fields-assess peripheral vision in all quadrants (confrontation test with fingers). If
available use Amsler Grid Chart. Corneal or periorbital burn-corneal ulcer or inflammation (fluorescein exam),
skin burns. Unequal, unreactive or abnormal pupils.
Using Advanced Tools: Ophthalmoscope: Hemorrhagic debris in the vitreous humor from retinal damage
(inability to focus on the retina); disrupted macula.
Assessment: Diagnose based on clinical signs and symptoms, environment and probability.
Differential Diagnosis
Traumatic eye injury (abrasion, blunt trauma, penetrating trauma, etc)
Infection (iritis, conjunctivitis, blepharitis, etc.)
Plan:
Treatment
Corneal Injury: Treat as an ultraviolet keratitis. If painful, apply topical anesthetic drops, a short
acting cycloplegic medication, topical ophthalmic antibiotic and patch. Evacuate if medically or operationally
indicated.
Vitreoretinal Injury: Maintain at bedrest if possible, with head elevated and eye(s) patched to facilitate blood
settling down and away from the macula. Immediate evacuation is recommended. Do not use steroids to
reduce intraocular inflammation without obtaining approval from a physician consultant.
Patient Education
Activity: Bedrest if operationally possible.
Prevention and Hygiene: Use laser protective eyewear in recognized threat environment.
Follow-up Actions
Wound Care: Maintain eye patch for 24 hours for corneal injury, and for the duration of evacuation in the
case of vitreoretinal injury.
Evacuation/Consultation Criteria: Evacuate as discussed above. Use chart below for additional guidance.
Consult ophthalmology or emergency medicine specialist for all cases of laser eye injuries.
Laser Exposure Evacuation Criteria:
Macular Damage
Visual Acuity Normal Minor Defect Major Defect
20/63 or worse in one/both eyes Evacuate Evacuate Evacuate
20/50 or better in both eyes Return to duty Reevaluate in 15 min. Evacuate