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Eye Injuries

Temple College

EMS Professions

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Eye Anatomy

Sclera

Choroid

Retina

Cornea

Iris

Pupil

Lens

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Eye Anatomy

• Aqueous humor: watery fluid which occupies the space between cornea and lens (anterior chamber)

• Vitreous humor: jelly-like fluid which fill space behind lens (posterior chamber)

• Conjunctiva: smooth membrane that covers front of eye

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Foreign Body

• Extraocular foreign body – Object on conjunctiva or cornea

• Intraocular foreign body– Object has penetrated cornea or sclera

• Contact lenses

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Extraocular Foreign Body

• Signs and Symptoms– Pain, foreign body sensation– Excessive tearing– Reddening of conjunctiva– Decreased visual acuity

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Extraocular Foreign Body

• Management– Inspect conjunctiva– Inspect surface of lower eyelid– Evert upper eyelid and inspect inner surface

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Extraocular Foreign Body

• Management– If object is over sclera or inside of eyelid, wash

out gently or remove with cotton tip applicator– Gently wash corneal bodies, do not touch– Cover both eyes– TRANSPORT– Evaluation for possible corneal abrasion needed

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Intraocular Foreign Body

• Signs and Symptoms– Pain/foreign body sensation– History of sudden eye pain following explosion

or metal-on-metal near eyes– Distorted light reflex over cornea or decreased

visual acuity– Peaked pupil

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Intraocular Foreign Body

• Management– Cover eyes– Avoid pressure– Cover large object with cup

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Contact Lenses

• Do NOT remove

• Move off cornea onto sclera

• Ensure receiving personnel are aware of contact lens presence

• Wash out only with chemical burns to eyes

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Burns

• Heat Burns– Usually due to flash of heat, flame– Eyes close reflexively, not usually burned– Don’t pry lids apart– Cover with sterile dressings and transport

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Burns

• Chemical Burns– TRUE OCULAR EMERGENCY!– Flush with large amounts of water or saline– Wash all the way to hospital– Wash medial to lateral – Wash out contacts

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Burns

• Chemical Burns– NEVER wash with anything other than water or

a balanced salt solution (NS or LR)– Do NOT introduce chemical “antidotes” into

eye

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Burns

• Light Burns– Superficial (sunburn, welding torches)

• Aching, severe pain

• Redness

• Eyelid spasms

– Deep (laser, looking directly at sun)• Blank spots in visual field

• May be permanent

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Burns

• Light Burns– Patch eyes with opaque dressing– Transport

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Penetrating Trauma

• Lid injuries– Moderate pressure control bleeding– Cover with moist dressing– Should be seen by ophthalmologist

• Lacerations of inner one-third of lid may damage tear-duct system

• Lacerations involving lid margins may cause notching

• Horizontal lacerations may damage levator muscle

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Penetrating Trauma

• Globe Laceration– Dark spots or streaks on sclera– “Jelly-like” material on eye or face

If in doubt, assume trauma to orbital area involves globe

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Penetrating Trauma

• Globe Laceration– Cover with moist sterile dressings– NO pressure– Cover both eyes

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Blunt Trauma

• Subconjunctival hemorrhage– Bruised eye

– Blood between conjunctiva and sclera; stops at margin of cornea

– No emergency

– Heals like any other bruise

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Blunt Trauma

• Hyphema– Blood in anterior chamber

– First bleed usually disappears rapidly

– Second bleed more severe; fills entire anterior chamber

– Increased intraocular pressure can cause blindness

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Blunt Trauma

• Blow out fracture– Eye pushed through floor of orbit into

maxillary sinus– Facial asymmetry, sunken eye, paralysis of

upward gaze,double vision, runny nose on injured side, numbness of lip on injured side

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Blunt Trauma

• Management– Cover both eyes– NO pressure

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Blunt Trauma

• Extruded eye– Pressure from blow pushes eye partially out of

orbit– Management

• Do NOT attempt to replace

• Keep eye surface moist

• Cover with cup

• NO pressure

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Face and Neck Trauma

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Face and Neck Trauma

• Attracts attention because of: – Bleeding– Swelling and deformity– Psychological impact

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Face and Neck Trauma

• Do NOT allow drama of facial injury to distract you from true problems such as:– Airway obstruction– Cervical spine injury– Intracranial trauma

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Airway Obstruction

• Bleeding

• Displaced teeth, dental appliances

• Deformity from fractures

• Edema from soft tissue trauma

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Facial Trauma Management

• Open Airway– Use jaw thrust – C-spine injury should be suspected– If necessary pull mandible, tongue forward to

clear airway

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Facial Trauma Management

• Clear blood, vomitus, other debris

• Save loose teeth, dental appliances– Teeth may be reimplanted– Teeth not accounted for must be assumed to

have been aspirated– Dental appliances necessary to provide support

to jaws for reconstruction

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Facial Trauma Management

• Apply pressure inside and outside of oral cavity to control bleeding

• Give O2, assist ventilations as needed

• Stabilize neck

• Monitor LOC, vital signs

• Transport

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Neck Trauma

• Large number of very vital structures compressed into very small area:– Trachea– Larynx– Carotid arteries– Jugular veins– Cervical spine, spinal cord

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Neck Trauma

• Penetrating Injury– Massive bleeding is significant problem– Apply direct pressure– If large veins involved:

• Apply bulky occlusive dressings

• Reduce possibility of air embolism

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Neck Trauma

• Penetrating Trauma– Injury to submental area (area under chin) =

Extreme caution!– Penetration of root of tongue can lead to:

• Massive bleeding into tongue

• Airway obstruction

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Neck Trauma

• Blunt injury– May crush larynx, trachea– Airway obstruction

• Leakage of air can produce subcutaneous emphysema

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Neck Trauma

• Blunt injury– Stabilize cervical spine

– Administer O2

– Assist ventilations gently with BVM– Consider ALS intercept for endotracheal

intubation or surgical airway