Eye Injuries

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Eye Injuries

• Temple College
• EMS Professions

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Eye Anatomy
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Eye Anatomy

• Aqueous humor watery fluid which occupies the
  space between cornea and lens (anterior chamber)
• Vitreous humor jelly-like fluid which fill space
  behind lens (posterior chamber)
• Conjunctiva smooth membrane that covers front of
  eye

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Foreign Body

• Extraocular foreign body
• Object on conjunctiva or cornea
• Intraocular foreign body
• Object has penetrated cornea or sclera
• Contact lenses

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Extraocular Foreign Body

• Signs and Symptoms
• Pain, foreign body sensation
• Excessive tearing
• Reddening of conjunctiva
• Decreased visual acuity

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Extraocular Foreign Body

• Management
• Inspect conjunctiva
• Inspect surface of lower eyelid
• Evert upper eyelid and inspect inner surface

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Extraocular Foreign Body

• Management
• If object is over sclera or inside of eyelid,
  wash out gently or remove with cotton tip
  applicator
• Gently wash corneal bodies, do not touch
• Cover both eyes
• TRANSPORT
• Evaluation for possible corneal abrasion needed

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Intraocular Foreign Body

• Signs and Symptoms
• Pain/foreign body sensation
• History of sudden eye pain following explosion or
  metal-on-metal near eyes
• Distorted light reflex over cornea or decreased
  visual acuity
• Peaked pupil

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Intraocular Foreign Body

• Management
• Cover eyes
• Avoid pressure
• Cover large object with cup

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Contact Lenses

• Do NOT remove
• Move off cornea onto sclera
• Ensure receiving personnel are aware of contact
  lens presence
• Wash out only with chemical burns to eyes

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Burns

• Heat Burns
• Usually due to flash of heat, flame
• Eyes close reflexively, not usually burned
• Dont pry lids apart
• Cover with sterile dressings and transport

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Burns

• Chemical Burns
• TRUE OCULAR EMERGENCY!
• Flush with large amounts of water or saline
• Wash all the way to hospital
• Wash medial to lateral
• Wash out contacts

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Burns

• Chemical Burns
• NEVER wash with anything other than water or a
  balanced salt solution (NS or LR)
• Do NOT introduce chemical antidotes into eye

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Burns

• Light Burns
• Superficial (sunburn, welding torches)
• Aching, severe pain
• Redness
• Eyelid spasms
• Deep (laser, looking directly at sun)
• Blank spots in visual field
• May be permanent

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Burns

• Light Burns
• Patch eyes with opaque dressing
• Transport

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Penetrating Trauma

• Lid injuries
• Moderate pressure control bleeding
• Cover with moist dressing
• Should be seen by ophthalmologist
• Lacerations of inner one-third of lid may damage
  tear-duct system
• Lacerations involving lid margins may cause
  notching
• Horizontal lacerations may damage levator muscle

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Penetrating Trauma

• Globe Laceration
• Dark spots or streaks on sclera
• Jelly-like material on eye or face

If in doubt, assume trauma to orbital area
involves globe
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Penetrating Trauma

• Globe Laceration
• Cover with moist sterile dressings
• NO pressure
• Cover both eyes

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Blunt Trauma

• Subconjunctival hemorrhage
• Bruised eye
• Blood between conjunctiva and sclera stops at
  margin of cornea
• No emergency
• Heals like any other bruise

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Blunt Trauma

• Hyphema
• Blood in anterior chamber
• First bleed usually disappears rapidly
• Second bleed more severe fills entire anterior
  chamber
• Increased intraocular pressure can cause
  blindness

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Blunt Trauma

• Blow out fracture
• Eye pushed through floor of orbit into maxillary
  sinus
• Facial asymmetry, sunken eye, paralysis of upward
  gaze,double vision, runny nose on injured side,
  numbness of lip on injured side

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Blunt Trauma

• Management
• Cover both eyes
• NO pressure

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Blunt Trauma

• Extruded eye
• Pressure from blow pushes eye partially out of
  orbit
• Management
• Do NOT attempt to replace
• Keep eye surface moist
• Cover with cup
• NO pressure

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Face and Neck Trauma
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Face and Neck Trauma

• Attracts attention because of
• Bleeding
• Swelling and deformity
• Psychological impact

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Face and Neck Trauma

• Do NOT allow drama of facial injury to distract
  you from true problems such as
• Airway obstruction
• Cervical spine injury
• Intracranial trauma

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Airway Obstruction

• Bleeding
• Displaced teeth, dental appliances
• Deformity from fractures
• Edema from soft tissue trauma

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Facial Trauma Management

• Open Airway
• Use jaw thrust
• C-spine injury should be suspected
• If necessary pull mandible, tongue forward to
  clear airway

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Facial Trauma Management

• Clear blood, vomitus, other debris
• Save loose teeth, dental appliances
• Teeth may be reimplanted
• Teeth not accounted for must be assumed to have
  been aspirated
• Dental appliances necessary to provide support to
  jaws for reconstruction

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Facial Trauma Management

• Apply pressure inside and outside of oral cavity
  to control bleeding
• Give O2, assist ventilations as needed
• Stabilize neck
• Monitor LOC, vital signs
• Transport

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Neck Trauma

• Large number of very vital structures compressed
  into very small area
• Trachea
• Larynx
• Carotid arteries
• Jugular veins
• Cervical spine, spinal cord

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Neck Trauma

• Penetrating Injury
• Massive bleeding is significant problem
• Apply direct pressure
• If large veins involved
• Apply bulky occlusive dressings
• Reduce possibility of air embolism

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Neck Trauma

• Penetrating Trauma
• Injury to submental area (area under chin)
  Extreme caution!
• Penetration of root of tongue can lead to
• Massive bleeding into tongue
• Airway obstruction

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Neck Trauma

• Blunt injury
• May crush larynx, trachea
• Airway obstruction
• Leakage of air can produce subcutaneous emphysema

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Neck Trauma

• Blunt injury
• Stabilize cervical spine
• Administer O2
• Assist ventilations gently with BVM
• Consider ALS intercept for endotracheal
  intubation or surgical airway