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Eye injury

Physicalor chemicalinjuries of the eyecan be a serious threat to visionif not treated appropriately and in a timely fashion. The most obvious presentation of ocular (eye) injuries is rednessand painof the affected eyes. This is not, however, universally true, as tiny metallicprojectilesmay cause neither symptom. Tiny metallic projectiles should be suspected when a patient reports metal on metal contact, such as with hammering a metal surface. Intraocular foreign bodies do not cause pain because of the lack of nerve endingsin the vitreousand retinathat can transmit pain sensations. As such, general or emergency roomdoctorsshould refer cases involving the posterior segment of the eye or intraocular foreign bodies to an ophthalmologist. Ideally, ointment would not be used when referring to an ophthalmologist, since it diminishes the ability to carry out a thorough eye examination.

Inhaltsverzeichnis

1 Investigation
- 1.1 Emergency
- 1.2 Urgent
- 1.3 Semi-urgent
2 Management
- 2.1 Irrigation
- 2.2 Patching
- 2.3 Suturing
3 See also

Investigation

The goal of investigation is the assessment of the severity of the ocular injury with an eye to implementing a management plan as soon as is required. The usual eye examinationshould be attempted, and may require a topical eye anestheticin order to be tolerable.

The first step is to assess the external condition of the eye and orbit, and check for perforations, hyphema, uveal prolapse, or globe penetration. If the pupilis teardrop-shaped, and the anterior chamber is flat, this is almost always a perforating injury of the corneaor limbal area.

Depending on the medical historyand preliminary examination, the primary care physician should designate the eye injury as a true emergency, urgent or semi-urgent.

Emergency

An emergency must be treated within minutes. This would include chemical burnsof the conjunctivaand cornea.

Urgent

An urgent case must be treated within hours. This includes penetrating globe injuries; corneal abrasionsor corneal foreign bodies; hyphema (must be referred)' eyelid lacerations that are deep, involve the lid margin or involve the canaliculi; radiant energy burns such as arc eye(welder's burn) or snow blindness; or, rarely, traumatic optic neuropathy.

Semi-urgent

Semi-urgent cases must be managed within 1-2 days. They include orbital fracturesand subconjunctival hemorrhages.

Management

Irrigation

The first line of management for chemical injuries is usually copious irrigationof the eye with an isotonicsalineor sterilewater. In the cases of chemical burns, one should not try to bufferthe solution, but instead diluteit with copious flushing.

Patching

Depending on the type of ocular injury, either a pressure patch or shield patch should be applied. In most cases, such as those of corneal abrasion or the like, a pressure patch should be applied that ensures some tension is applied to the eye, and that the patient cannot open her or his eye under the patch. In cases of globe penetration, pressure patches should never be applied, and instead a shield patch should be applied that protects the eye without applying any pressure.

Suturing

In cases of eyelid laceration, sutures may be a part of appropriate management by the primary care physician so long as the laceration does not threaten the canaliculi, is not deep, and does not affect the lid margins.