Page 26 - 2023 SMOG Digital

Trauma

EYE INJURY / PAIN

Signs and Symptoms: Differential Diagnosis:
• Pain, Swelling, Blood • Abrasion/Laceration
• Decreased Visual Acuity/Blindness • Globe Rupture/Orbital fracture
• Deformity/Contusion • Retinal Detachment
• Foreign Body • Chemical/Thermal Burn
• Excessive Tearing • Infection/Iritis
• CNS Event
• Glaucoma
• Retinal Vessel Occlusion
Universal Patient Care Guideline If possible, obtain visual acuity on
all eye patients using pocket size
Snellen chart.
WITHOUT KNOWN INJURY PAIN WITH INJURY
Move to:
Evaluate Pupils ISOLATED and without additional NO Appropriate
and more significant Injuries? Guideline,
YES and return after
completing life
Previously unrecognized chemical Assess orbital stability / pupils and limb saving
exposure? YES interventions

NO
CHEMICAL TRAUMA
Cover both eyes
Copious irrigation with NS for Remove loose debris with NS
chemical exposure – irrigation. Do not attempt to
30min Minimum! remove impaled objects or
contacts.
If penetrating
For Nausea trauma give
Give Ondansetron 4-8mg IV/IO/IM Moxifloxacin Cover w/ rigid eye shield DO NOT
400mg PO/IV PLACE ANY DRESSINGS UNDER
For Anxiety SHIELD.
Consider Diazepam 2-10mg IV/IO O/IM
OR
Consider Midazolam 2.5-5mg IVP PAIN CONTROL Guideline
Pearls:
• Antiemetics are essential to prevent increased IOP. Consider Benzo for anxiety.
• Use rigid eye shields, not pads, for traumatic injuries. Can use a soft pad on unaffected eye.
• Patching both eyes to decrease sympathetic eye movements has not been shown to improve visual
outcome but may increase anxiety and will render patient unable to move independently.
• If globe is out of socket – do not attempt to replace. Cover with saline soaked gauze
• Copious irrigation is the cornerstone of treatment for chemical eye injuries. 30 min is the minimum
amount of time to irrigate. Utilize Morgan lens if available.
o The use of a nasal cannula across the bridge of the nose attached to 1L of NS will also work.

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