Download Penetrating eye injury

Penetrating eye injury
Recommend
 Do not remove any penetrating foreign body
 Do not instil local anaesthetic eye drops or use fluorescein staining or eye drops / ointment if penetrating
eye injury is suspected or obvious
 NEVER pad an eye where penetrating eye injury is suspected or present. Use an eye shield or cut down
styrofoam cup
 Any penetrating eye injury (obvious or suspected) requires specialist management
 Consult MO urgently
Related topics:
Assessment of the eye, page 253
O2 Delivery systems, page 39
 Foreign body / corneal abrasion, page 257
 Tetanus immunisation, page 129
1.
May present with:
 History of high velocity foreign body injury
 Obvious injury
 Pain
2.
Immediate management:
 Give oxygen via Hudson mask (see O2 Delivery systems) to maintain saturation >94%. If >94% not
maintained Consult MO (the eye has a high oxygen requirement and it is important to maintain this
when injured)
 Consult MO
3.
Clinical assessment:
 Obtain patient history with particular note of mechanism of injury [1]
 type of projectile?
 high velocity?
 note if patient wearing eye protection
 Perform standard clinical observations + oxygen saturations and pain score
 Do not use local anaesthetic eye drops
 Do not use fluorescein staining
 Examination may only need to be cursory if the trauma is obvious, otherwise [1]
 perform visual acuities
 describe extent of injury
 check red eye reflex – loss of reflex may suggest retinal trauma or detachment [1]
4.
Management:
 Do not remove penetrating object
 Do not pad the eye
 Consult MO who will advise
 X-ray (if available) if history of high velocity foreign body and unsure if has penetrated eye
 analgesia - it is important the patient’s pain is controlled
 antiemetic - it is very important to prevent vomiting which can raise intraocular pressure
and cause extrusion of eye contents
 antibiotics (eg. IV Ceftriaxone plus Gentamycin)
 preparation for evacuation / hospitalisation
 Give nil by mouth
 A solid eye shield either pre-made or a cone constructed from cardboard or a styrofoam cup should
be fixed over the injured eye. The base should rest on the orbital margin. This prevents any
accidental pressure on the globe. The injured eye should not be padded as any extruded ocular
contents may stick to the pad causing further injury when the pad is removed
 Nausea is common in eye injuries. Treat with Metoclopramide (adults) or Prochlorperazine
 Children, people with Parkinson’s Disease and women < 20 years of age should not receive
Metoclopramide (Maxolon) or Prochlorperazine (Stemetil) because of the high risk of dystonic reactions. If
an antiemetic is required for a child the MO may advise Promethazine (Phenergan) IV slowly or IM stat
(0.5 mg/kg, max. 25 mg)
 Check when had last tetanus vaccination, see Tetanus immunisation
Schedule
4
Metoclopramide
DTP
IHW / RIN / NP/ IPAP
Authorised Indigenous Health Workers and Isolated Practice Area Paramedic must consult MO
Rural and Isolated Practice Endorsed Registered Nurses may proceed
Nurse Practitioners may proceed
Route of
Recommended
Form
Strength
Duration
Administration
Dosage
Ampoule
10 mg in 2 mL
IM
Adults only: 10 mg
Stat
Ampoule
10 mg in 2 mL
IV (RN only)
Adults only: 10 mg
Stat
Provide Consumer Medicine Information if available:
Management of Associated Emergency: Dystonic reactions eg. oculogyric crisis are extremely rare (unless repeated doses or
in children). If oculogyric crisis develops give Benztropine 2 mg IMI or IVI as per Mental health emergencies
Or:
DTP
Schedule
4
Prochlorperazine
IHW / RIN / NP / IPAP
Authorised Indigenous Health Workers and Isolated Practice Area Paramedic must consult MO
Rural and Isolated Practice Endorsed Registered Nurses may proceed
Nurse Practitioners may proceed
Form
Strength
Route of Administration
Recommended Dosage
Duration
Tablet
5 mg
Oral
Adults only: Single dose only,
Stat
max. 5 mg
Provide Consumer Medicine Information if available:
Management of Associated Emergency: Dystonic reactions eg. oculogyric crisis are extremely rare (unless repeated doses
or in children). If oculogyric crisis develops give Benztropine 2 mg IMI as per Mental health emergencies
5.
Follow up:

All patients with penetrating eye injury require evacuation/hospitalisation under the care of an
Ophthalmologist

If the patient is to be evacuated by aircraft and:
 the characteristics of the injury are suggestive of significant intraocular air, ie. large
penetrating foreign body, prolapse of globe contents or there is detectable intraocular air on
examination or CT scan (if available), then the patient should be transferred at sea level cabin
pressure
 the likelihood of significant intraocular air is minimal, ie. small, high velocity foreign body, then a
cabin altitude of <4,000 feet is acceptable
 if in any doubt the characteristics of the injury should be discussed with the receiving
Ophthalmologist
6.
Referral / Consultation:
 Consult MO on all occasions of suspected penetrating eye injury