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HKCEM College Tutorial. Traumatic Eye Emergencies. Author Dr. TW Wong revised by Dr. Lam Pui Kin, Rex Oct., 2013. Objectives. Understand how to manage Eye injuries due to foreign body Blunt eye trauma Chemical injury. Case 1. M 40 R Eye discomfort after ? FB to eye

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Traumatic Eye Emergencies

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HKCEM College Tutorial

Traumatic Eye Emergencies


Dr. TW Wongrevised by

Dr. Lam Pui Kin, Rex

Oct., 2013


Understand how to manage

  • Eye injuries due to foreign body

  • Blunt eye trauma

  • Chemical injury

Case 1

  • M 40

  • R Eye discomfort after ? FB to eye

  • Drilling with an electric drill

  • Tearing ++

What do you find?

What is the likely dx?

Metallic Foreign Body (FB) to the eye

What is the most important point in examination ?

Visual Acuity

If a corneal FB (iron dust) is found...

  • What is the treatment?

Metallic FB in cornea

  • Should be removed under topical LA

  • In hospitals without urgent eye support, removal of non-axial FB can be attempted

  • Axial/ full thickness FB should be removed by eye specialists

  • rust ring need to be removed to prevent siderosis

  • antibiotic eyedrop +/- mydriatic

  • ATT

  • eye pad is not necessary

If no obvious FB is noted, where else should you look for an FB


Upper fornix by everting eyelid

FB upper fornix

Remove FB with

a moistened

cotton tip

Irrespective of whether a FB is found

What further test is necessary?

Stain for cornea abrasion

What is the treatment for this?

Corneal abrasion

  • LA eye drop (e.g. novesin) stat for pain control

  • antibiotic eye drop

  • oral analgesic prn

  • ATT

  • urgent referral for eye FU

  • no need for patching

What about this patient?

Subconjunctival FB-- a piece of wood

Penetration of globe should be R/O

Think about ruptured globe if …

  • High velocity projectiles

  • Shallow anterior chamber

  • Hyphema

  • Irregular pupil or the pointing sign

  • Prolapsed iris

  • Bullous subconjunctival hemorrhage

  • Lens dislocation or opacification

  • Siedel test

  • Vitroeus hemorrhage

  • Retinal detachment

Seidel’s test

How to manage FB associated globe rupture?

  • Avoid pressure over injured globe

  • Supine

  • Rigid eye shield

  • Leave FB undisturbed

  • IV antibiotics

  • Pain control +/- antiemetic

  • ATT

  • NPO

  • Urgent Ophthalmologist consult

You only find subconjunctival hemorrhage

What would you do next ?

X-ray orbit for IO FB

High velocity FB e.g. hammer & chisel injury

Case 2

  • M 25

  • Injury R eye

  • Hit by the badminton cock by accident during a game

  • R eye pain with VA impaired

Exam for acute VA loss

  • Cornea

  • Anterior chamber

  • Lens

  • Vitreous

  • Retina

  • Visual field

  • EOM

Corneal laceration

What about this eye ?

What else do you need to check?


  • <20% in this patient

  • total hyphema => visual loss

  • rest in an upright position advised

  • urgent eye consult needed

  • Watch out for associated injuries and complications

Visual prognosis

What if the patient complains of floaters and flashes only with no obvious external injuries?

Consider retinal detachment until proven otherwise

What bedside investigation may help in diagnosis?

Bottom line: Blunt injury +  VA

Urgent referral to eye is necessary even if exam is normal in ED

Case 3

  • F 35

  • unknown chemical spilled into eye

  • severe pain at first

  • irrigation done with tap water in workplace

  • VA difficult to test due to blepharospasm

What is the most important property about the chemical that we need to know ?


Which is worse? Acid or alkali

  • Alkali can cause persistent injury

  • liquefactive necrosis

How do you test for pH ?

Testing for pH

What is the normal

pH for tear?

What should be our ED Tx ?

Irrigation till pH normalise

LA eye drop

Eye retractor

NS via drip

Remember to retract lids and swab fornicesfor particulate matter

Urgent refer to eye for all cases

  • Alkali burn

  • impaired VA

  • Corneal stain +ve


We have covered:

1. Eye injuries due to FB

2. Blunt eye trauma

3. Chemical injury

The end

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