The eye is a delicate external organ and it is easy for it to be injured. Eye injuries are generally classified as penetrating and non penetrating and include corneal and conjunctival foreign bodies and abrasions, burns (dry heat and chemical burns), blunt trauma (contusion), penetrating injuries to the eyeball (perforations), injuries to eyelids, orbital injuries, and cranial nerve injuries.
A Good evaluation of eye injury includes the following:
- Checking vision for all patients.
- Good lighting and magnifying lens make eye examination easier.
- Eye examination to be carried out should be thorough, noting that a small entry wound does not always equate to minimal injury.
Management
- Corneal and conjunctival abrasions:
- Pad the eye with doxycycline eye ointment 1% for 24 hours.
- Stain with fluorescein and then manage accordingly.
- Foreign bodies:
- Use moist cotton swabs.
- Remove under local anaesthesia (by a trained person) then pad the eye.
- Apply doxycycline eye ointment 1% 3 times a day.
- Refer to higher level if at 4 or 5 and unabl;e to remove or if the instruments are lacking.
- Blunt trauma:
- Give analgesics.
- Rest the eye.
- Caution as this may be a ruptured eyeball.
- Deal with or refer those with poor vision and/or blood in the eye (hyphema) immediately to the next level if not able to manage.
- Chemical burn:
- Urgently irrigate the eye with plenty of water or normal saline for 30 minutes. Note that washing the face is not enough.
- Use local anaesthetic ophthalmic drugs, e.g., lignocaine 4% eye drops.
- Pad with tetracycline eye ointment 1%.
- Refer immediately to a higher center, preferably with an eye specialist.
- Deal with complications or refer to eye specialists very urgently.Complications depend on the concentration of the chemical and the duration it stays in the eye.
- Penetrating eye injuries
- Give an injection tetanus toxoid (IM) STAT.
- DO NOT apply topical medications to the eye.
- Protect the eye with a clean pad or shield.
- Refer without delay to a resident eye specialist. Communicate directly with specialists prior to transfer.
- Lid injuries
- Dress wound.
- Gives tetanus toxoid.
- Lids have very good blood supply and so healing is good.
- Stitch minur cut involving lid margin if you are a trained professional.
- Avoid distorting the lid margin.
- Refer if tissue loss and all patients injured lacrimal drainage system (nasal anagle of the eye).
- Septic lacerations should be cleaned and covered with systemic antibiotics benzyl penicillin 1.2 h IV 6 hourly+gentamicin 80mg 8 hourl;y for 7 days.
- Note: Refer all patients with injuries involving the lid margin.
- Orbital injuries
- Proptosis (protruding eye) or diplopia (double vision) suggest serious eye injury for whi9ch specialist assessment and treatment are required.
- Tetanus toxoid injection STAT should be given if there is an open wound.
- Take orbital x-ray of the patients with suspected fractures of the orbit.
- Give systemic antibiotics (penicilins:amoxycilin 500mg 8 hourly amoxicillin +clavbulanic acid 625 mg 12 hourly), and anal;gesics(paracetamol 1gm orally hourly and for children refer to appropriate appendix).
- Refer for specialized treatment.