1. Temple College EMS Professions
1/3/2018
Eye Injuries
Temple College
EMS Professions
Temple College EMS Professions

2. Eye Anatomy
Sclera
Iris
Choroid
Pupil
Lens
Cornea
Retina

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 Intraocular 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. If in doubt, assume trauma to orbital area involves globe
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
Do NOT 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