Page 19 - Journal of Special Operations Medicine - Summer 2014

Corneal Foreign Body Management at a
Role 1 Flight Line Aid Station

Risks, Benefits, and Implications for Special Operations Medicine

Christopher J. Calvano, MD, PhD; Robert W. Enzenauer, MD, MPH, MSS, MBA;
Jack W. Wenkel, PA-C; Jessica L. Henke, BS; Christiana K. Rohrbough, RDH;
Stephanie L. Miller, BSN; Paul H. Howerton, BS; James P. Schreffler, MS

ABSTRACT
Eye injuries are common in forward areas of operations. exposures, and he was wearing protective eyewear asso-
Definitive diagnosis and care may be limited not by pro- ciated with his usual flight equipment. His past medical
vider skill but rather by available equipment. The ability history was negative for systemic or ophthalmic disease.
to treat simple trauma such as corneal foreign bodies at Visual acuity was 20/15 OU, pupils were round and re-
the Role 1 level has advantages including rapid return to active OU with no afferent pupillary defect, and tonom-
duty, decreased cost of treatment, and, most important, etry was not available. The ocular adnexa were normal
decreased risk of delayed care. We propose the device bilaterally with no evidence of injury, laceration, or for-
such as a hand-held portable slit lamp should be made eign bodies. With use of a handheld slit lamp (Figure
available for appropriate Special Operations Medical 1), the left cornea was examined. A sub-1mm-diameter
Forces (SOFMED) or aviation providers. embedded foreign body was identified at the 12 o’clock
position in the mid-periphery 3mm from the limbus
Keywords: ocular, trauma, slit lamp, Role 1, aviation, special (Figure 2). It was at approximately 25% depth within
operations medicine the cornea stroma. (Depth perception is facilitated be-
cause the user views the target with both eyes through
the slit lamp beam via the loupe lens.) We irrigated the
cornea using sterile saline and an 18-gauge angiocath-
Introduction
eter but were unable to dislodge the foreign body. Visu-
Combat aviation is often a critical component of the alizing the eye using the slit lamp, we were able to safely
fifth “SOF truth”: SOF often need non-SOF support. lift the foreign body free of the corneal stroma. The eye
Illnesses and injuries that compromise mission success was Seidel negative and vision was 20/15 both before
warrant prioritized attention to minimize downtime. and after the procedure. (The Seidel test uses fluorescein
For example, an embedded corneal foreign body in a dye placed on a suspected injured eye to visualize a pos-
pilot is likely a grounding event because it is visually sible stream of anterior chamber aqueous humor, which
debilitating. It may require transfer to the nearest higher
level facility with ophthalmology care and equipment
capacity which lengthens the down period. This report Figure 1 The Eilodon Hand Held Slit Lamp Model 510LS
will discuss the management of a corneal foreign body (Loupe System).
(FB) using a handheld portable slit lamp at a Role 1
flight line aid station in theater. We will also examine the
likely “pros and cons” of providing such equipment to
skilled aviation and SOF medics in forward and austere
environments.

Case Presentation
A 25-year-old U.S. military aviator presented to the flight Eilodon Inc.; www.Slitlamp.com
line aid station with complaints of left eye pain and irri-
tation and inability to sleep following a mission. He re-
ported no known injury and no blast or environmental

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