Page 269 - ATP-P 11th Ed

OPEN GLOBE INJURY PROTOCOL

SPECIAL CONSIDERATIONS
1. High index of suspicion is essential for OGI.
2. Prognosis for visual acuity best if surgery performed within 24 hours of injury.

Signs and Symptoms
1. History of blunt or sharp trauma to ocular region SECTION 2
2. Risk increased with concurrent penetrating periocular or head trauma
3. Suspicious findings: Peaked pupil, abnormal anterior chamber depth, 360° subconjunc-
tival hemorrhage
4. Definitive findings: obvious laceration/rupture, prolapsed intraocular contents
5. Visual acuity usually decreased, but may be close to normal with small lacerations
6. Afferent pupillary defect
7. Positive Seidel test (see below)
Management
1. Rigid eye shield (no gauze/padding) to prevent further injury; NO PRESSURE ON
EYE.
2. Do not instill topical medications if suspicious for OGI.
3. Use of ultrasound contraindicated in suspected OGI.
4. Ondansetron (Zofran ) 4mg IM or 4mg IV over 2–5 minutes.
®
5. Moxifloxacin (Avelox ) 400mg PO/IV (repeat daily for delayed evacuation) for
®
prevention of intraocular infection (endophthalmitis). Give ertapenem (Invanz ) 1g IV/
®
IM once a day if IV moxifloxacin not available.
6. Treat per Pain Management Protocol; ketamine cleared for use.
7. Maintain patient comfort and supine/head elevated positioning.
8. No altitude restrictions for suspected OGI.

Disposition
1. Urgent evacuation
2. Consider teleconsultation with photos if evacuation delayed.
3. Add clindamycin 300mg IV q8hr for delayed evacuation.

258 SECTION 2 TACTICAL MEDICAL EMERGENCY PROTOCOLS (TMEPs) ATP-P Handbook 11th Edition 259