Eye Injuries

1. Eye Injuries Temple College EMS Professions

2. Sclera Iris Choroid Pupil Cornea Retina Lens Eye Anatomy

3. 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

4. Foreign Body • Extraocular foreign body • Object on conjunctiva or cornea • Intraocular foreign body • Object has penetrated cornea or sclera • Contact lenses

5. Extraocular Foreign Body • Signs and Symptoms • Pain, foreign body sensation • Excessive tearing • Reddening of conjunctiva • Decreased visual acuity

6. Extraocular Foreign Body • Management • Inspect conjunctiva • Inspect surface of lower eyelid • Evert upper eyelid and inspect inner surface

7. 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

8. 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

9. Intraocular Foreign Body • Management • Cover eyes • Avoid pressure • Cover large object with cup

10. 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

11. 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

12. 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

13. 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

14. 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

15. Burns • Light Burns • Patch eyes with opaque dressing • Transport

16. 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

17. 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

18. Penetrating Trauma • Globe Laceration • Cover with moist sterile dressings • NO pressure • Cover both eyes

19. Blunt Trauma • Subconjunctival hemorrhage • Bruised eye • Blood between conjunctiva and sclera; stops at margin of cornea • No emergency • Heals like any other bruise

20. 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

21. 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

22. Blunt Trauma • Management • Cover both eyes • NO pressure

23. 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

24. Face and Neck Trauma

25. Face and Neck Trauma • Attracts attention because of: • Bleeding • Swelling and deformity • Psychological impact

26. Face and Neck Trauma • DoNOT allow drama of facial injury to distract you from true problems such as: • Airway obstruction • Cervical spine injury • Intracranial trauma

27. Airway Obstruction • Bleeding • Displaced teeth, dental appliances • Deformity from fractures • Edema from soft tissue trauma

28. Facial Trauma Management • Open Airway • Use jaw thrust • C-spine injury should be suspected • If necessary pull mandible, tongue forward to clear airway

29. 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

30. 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

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

32. 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

33. 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

34. Neck Trauma • Blunt injury • May crush larynx, trachea • Airway obstruction • Leakage of air can produce subcutaneous emphysema

35. Neck Trauma • Blunt injury • Stabilize cervical spine • Administer O2 • Assist ventilations gently with BVM • Consider ALS intercept for endotracheal intubation or surgical airway