Page 71 - 2021 Advanced Ranger First Responder Handbook

Eye Injury
Eye Injuries
Penetrating injuries to eye globe or fracture of the orbit must be assessed with any facial trauma in the combat set-
ting. Penetrating wounds of the eye may be very common from shrapnel and debris. Blunt trauma that may disrupt the
integrity of the globe may be seen during facial trauma from falls, PLF, FRIES landings, hand-to-hand combat or motor
vehicle accident (MVA)-type collisions. The primary management in any setting includes a rigid eye shield that does not
put pressure on the globe of the eye. Avoid any manipulation of eye or eye globe if penetrating injury is suspected. Infec-
tion may later cause permanent loss of vision, so early broad-spectrum systemic antibiotic therapy is critical to prevent
post-traumatic endophthalmitis.

TCCC Application
Care Under Fire: Stop life-threatening bleeding.
Tactical Field Care/Tactical Evacuation: If a penetrating eye injury is noted or suspected, perform a rapid field test of
visual acuity and document findings. Cover the eye with a rigid eye shield (NOT a pressure patch). Ensure that the 400mg
moxifloxacin tablet in the combat pill pack is taken if possible. If able to take PO: moxifloxacin, 400mg PO once a day.
If unable to take PO: ertapenem, 1g IV/IM once a day.

Extended Care
Retrobulbar Hematoma: Blunt or penetrating eye trauma may result in bleeding. As the pressure in the eye socket
is progressively elevated, the eye pressure will also rise. If eye pressure rises to a high enough level, vision may be
permanently lost in the eye. Signs/symptoms of retrobulbar hemorrhage include pain, black eye, progressive proptosis
(bulging forward of the eye), and decreased vision. The definitive management for this disorder is a lateral canthotomy
that can be performed by Ranger Medics.
Rapid Field Visual Acuity Test Eye Examination (TRAUMA)
Visual acuity is the vital sign of the eye Inspect surrounding structures: Inspect the symmetry of the
in your assessment. Vision in affected eyes, eyebrows, and orbital area for any abnormalities.
eye should be checked with unaffected Eyelids: Inspect the patient’s lightly closed eyelids for symmetry,
eye closed. A simple quantification is fasciculation, tremors, and presence of eyelashes. While closed,
from best to worst:
look to ensure eyelids close completely.
1. Able to read print. Pupils: Equal, round, reactive to light, distortion, size
2. Can count the number of fingers
held up. Iris: Details clear, laceration or indication of penetrating trauma
3. Can see hand motion. Sclera: Obvious lacerations, redness, blood in white part of the eye
4. Can see light.
Cornea: Obvious defects (laceration or penetration)
Document the finding on casualty card.
Ocular Motion: Inability to move eye
Standard Visual Acuity Test
Distant visual acuity is tested using a Snellen chart with patient 20ft away in a well-lit area. Test each eye separately, with
one eye being covered while testing the opposite eye. Allow a few moments for eyes to adjust between tests. If patient
wears corrective vision, record two separate tests, one with and one without correction. Documentation is recorded as a
fraction in which the numerator indicates the distance from the chart (20) and the denominator indicates the distance at
which the average eye can read the line. (i.e., 20/40 indicates the patient is reading at 20ft what the average eye can read
at 40ft. Tell patient to read the line most clear to them and then proceed to the next distance level. Record the distance
in which the patient can still accurately read the text.
Peripheral visual acuity is tested using the confrontation test. Stand facing the patient at eye level and test each eye
separately. While the patient covers one eye, you cover the opposing eye (Patient–Left, Examiner–Right). Fully extend
your arm midway between yourself and the patient and then move it centrally with the fingers moving. Have the patient
tell you when the moving fingers are first seen. Compare the patient’s response with your response in the upper, lower,
left and right spectrums. Record as the estimated degrees of vision, with directly ahead being 0 degrees. MISC

2021 ADVANCED RANGER FIRST RESPONDER HANDBOOK 61