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the risk of rebleeding. Additionally, provide antiemetics such as Conclusion
5
ondansetron to mitigate elevated IOP from emesis. If an open
globe is suspected with symptoms such as loss of visual acuity, Treating ocular injuries in an austere environment presents
a flattened anterior chamber, obvious laceration, or intraocular several challenges that SOF providers must overcome. Acute
foreign body, avoid manipulating the eye, measuring IOP, or traumatic ocular injuries are common in the deployed setting,
5
applying any pressure to the globe. Provide symptomatic relief and this case depicts the importance of early recognition and
and evacuate the patient as soon as tactically feasible. treatment of a traumatic grade 1 hyphema with commotio
retinae at a Role 2 facility. Despite being geographically sep-
arated from specialty clinics, the use of telemedicine proved
Truck
If increased ocular pressure is suspected but a tonometer pen invaluable in providing real-time feedback and evaluation,
is not available, assess for a significant difference in ballotte- leading to expedited treatment. The strategic evacuation of the
ment of the uninjured versus injured eye with closed eyelids. UAS operator through the Army Health System’s levels of care
However, pressing on an open globe injury must be avoided at played a pivotal role in enhancing patient outcomes and facili-
all costs. Some concerning signs for open globe include 360° tated a prompt return to duty for the Servicemember.
subconjunctival hemorrhage, positive Seidel test, grade ≥3 hy- Author Contributions
phema, peaking of the pupil, and pigment on or underneath SRB and KEH saw the patient after the injury, KEH treated the
3
the conjunctiva. If none of these signs are present, raising sus- patient at the Role 2 facility. SRB, KEH, and REB decided to
picion for an open globe injury, a ballottement test involves write a case report for submission to the JSOM. JWK provided
very gentle palpation over the medial and lateral canthi of telephonic consultation and reviewed the ophthalmologic
each eye. The ballottement of the injured eye can be compared treatments described in the case. REB reviewed and approved
to the uninjured eye of the patient or the eye of the exam- the final manuscript.
iner. Globes with elevated IOPs will be firmer than an unin-
jured eye. A field expedient way to assess for increased IOP is Disclaimer
that upon gentle ballottement, an eye with elevated pressures The view(s) expressed herein are those of the author(s) and
would provide feedback like that of a hard-boiled egg. If found do not reflect the official policy or position of 160th SOAR
on examination this could be a sensitive sign for vision-threat- (Airborne), the U.S. Army Medical Department, United States
ening elevation in IOP.
Army Special Operations Command, the U.S. Army Office of
the Surgeon General, the Department of the Army, Depart-
House ment of Defense or the U.S. Government.
A more objective measurement of IOPs is performed with a
tonometer pen (e.g., Tono-Pen, iCare tonometer). This light- Disclosures
weight, simple device allows for the measurement of IOP The authors have nothing to disclose
readings that can guide treatment modalities and evacuation
considerations. If this device is not available, access to an ultra- Funding
sound can provide additional information about the affected No funding was received for this work.
eye, particularly the posterior chamber. Ocular ultrasound can
detect vitreous hemorrhage, lens dislocation and rupture, de- References
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ophthalmologist will provide valuable feedback and specialty 2. U.S. Army Public Health Center. Technical Information Paper No
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Active Components of the U.S. Armed Forces. Published 2021. Ac-
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