#EMconf: Ocular Trauma Pearls

Quick Guide to Ocular Trauma: 

  • Globe rupture suspected on exam? STOP! Put nothing in the eye (even fluorescein if possible), place a shield over the eye.  Call OPTHO stat!  
  • Acid / base splashes? Irrigate copiously with water until pH normalizes (~7.2). If damage noted or vision changes, call ophtho.
  • Foreign objects or debris under the eyelid? Remove with a cotton swab.  How to evert eyelids: https://www.youtube.com/watch?v=AceOwfpPWNw 
  • Triad of proptosis, decreased extraocular movement and visual loss?  Think retrobulbar hematoma. Consider lateral canthotomy.   True eye emergency! 
  • Check for afferent pupillary deficit, visual field deficits and changes in visual acuity.  If any of these are present in the setting of trauma, strongly consider optho evlauation for a more detailed ocular exam
  • Check extra ocular movements. Unable to look superiorly, consider Inferior rectus entrapment from orbital floor fracture 
  • Hyphema present?  Grade 3 or higher: call optho otherwise, timolol eye drops.  Complications include rebleeding and glaucoma (especially in Sickle Cell patients) so remember to check IOP! 
  • Complicated lid laceration: affecting medial half of eye lids, fat prolapse, full thickness wound? Call ophtho 
  • Corneal abrasions? Don’t forget the antibiotics! If they are contact lens wearers use quinolone based antibiotic