Page 29 - 2026 SMOG

EYE INJURY/PAIN
History History (Complications)
• Pain, swelling, blood • Abrasion/laceration
• Decreased visual acuity/blindness • Globe rupture/orbital fracture
• Deformity/contusion • Retinal detachment
• Foreign body • Chemical/thermal burns
• Excessive tearing • Infection/iritis
• CNS event
• Glaucoma
• Retinal vessel occlusion
Treatment
• Without Known Injury
˚ Evaluate pupils
Consider unrecognized chemical exposure. See below for chemical injury
˚
• With Known Injury
˚ If not isolated, move to the appropriate protocol to treat life threats
Assess orbital stability/pupils
˚
• Chemical Injury
˚ Irrigate with a minimum of 2L NS, LR, water, or neutral irrigation solution; may require up
to 10L
• Traumatic Injury
˚ Remove loose debris with NS irrigation. Do not attempt to remove impaled objects or
contacts
˚ Cover with rigid eye shield. Do not place any dressing/padding underneath the eye shield
˚ If laceration, penetration, or rupture of the globe occurs, give:
■ Levofloxacin 750mg IV/PO q24hr plus Vancomycin 15–20mg/kg IV q8–12hr
OR
■ Moxifloxacin 400mg IV/PO q24hr
• Treat for nausea and vomiting aggressively with Ondansetron 4–8mg IV
• Provide sedation and analgesia prn (maintain patient comfort)
Notes, Cautions, Warnings
• Assess and document visual acuity for each eye, if possible.
• Antiemetics are essential to prevent increased ICP. Consider benzodiazepines for anxiety.
• Use rigid eye shields, not pads, for traumatic injuries.
• Patching both eyes to decrease sympathetic movement has not been shown to improve visual
outcome, but may increase anxiety and will render the patient unable to move independently.
• If the globe is out of socket, do not attempt to replace it. Cover with saline-soaked gauze.
• Copious irrigation is the cornerstone of treatment for chemical eye injuries. Some chemical
injuries can require up to 10L. 30 minutes is the minimum amount of time to irrigate. Utilize a
Morgan Lens if available.
˚ The use of a nasal cannula across the bridge of the nose, attached to 1L of NS, will
also work.
Reference: CPG ID #03 (Eye Trauma: Initial Care)

2026 Standard Medical Operating Guidelines (SMOG) • 21