Eye Trauma (Foreign Body, Blunt, Penetrating, Chemical)

Clinical assessment

History of injury mechanism is crucial. Assess Visual Acuity first (if possible). External examination (lids, conjunctiva, cornea, pupil, anterior chamber). Evert eyelids to check for hidden FB. Fluorescein staining for abrasions/penetrating wounds (Seidel test). Assess eye movements and pupil reactions. Palpate orbital rim if blunt trauma.

Investigations

• Visual Acuity test.
• Fluorescein Staining.
• Slit Lamp Examination (specialist).
• Dilated Fundus Examination (specialist - check for intraocular damage after blunt/penetrating trauma).
• X-ray / CT Scan (Orbit): If intraocular foreign body or orbital fracture suspected.
• B-scan Ultrasound: If view obscured by hyphema/cataract.

Diagnostic criteria

Diagnosis based on history and examination findings specific to the type of injury.

Non-pharmacological management

• Superficial Corneal/Conjunctival FB: (LOC: HC2/3)
• - Attempt removal with moistened cotton bud or gentle irrigation with Normal Saline after topical anaesthetic drop.
• - Evert eyelid to check fornices.
• - If fails, refer.
• Corneal Abrasion: (LOC: HC2/3)
• - Ensure no retained FB.
• - Instill antibiotic ointment (Tetracycline/Chloramphenicol).
• - Eye patching sometimes used for comfort (large abrasions), but controversial (may delay healing/increase infection risk). Often just recommend sunglasses.
• - Follow up daily until healed.
• Blunt Trauma: (LOC: HC2/3 initially, Refer if severe/vision loss)
• - Cold compresses for swelling.
• - Assess for intraocular injury. If vision reduced, hyphema, pupil distortion, pain with movement -> Urgent Referral.
• Penetrating/Perforating Injury: (LOC: HC2/3 -> IMMEDIATE REFERRAL)
• - DO NOT REMOVE protruding object.
• - DO NOT PAD the eye. Apply a rigid protective shield (e.g., bottom of paper cup taped over orbit) to avoid pressure.
• - Keep patient NPO (Nil Per Os).
• - Provide analgesia and antiemetic (prevent straining).
• - Give Tetanus prophylaxis.
• - IMMEDIATE URGENT REFERRAL to Eye Specialist/Hospital for surgical repair.
• Chemical Injury: (LOC: HC2/3 -> IMMEDIATE REFERRAL after irrigation)
• - IMMEDIATE, COPIOUS IRRIGATION with sterile Normal Saline, Ringer's Lactate, or clean water for at least 15-30 minutes. Use eyelid speculum/retractors if needed to ensure thorough flushing of fornices.
• - Check pH with litmus paper (aim for neutral pH 7.0-7.4). Continue irrigation until neutral.
• - Apply antibiotic ointment.
• - Apply cycloplegic drop (e.g., Atropine).
• - IMMEDIATE URGENT REFERRAL to Eye Specialist/Hospital.

Pharmacological treatment

• Topical Anaesthetic (e.g., Tetracaine, Proxymetacaine): For examination and FB removal ONLY. DO NOT prescribe for home use (delays healing, masks worsening).
• Topical Antibiotic Ointment/Drops (e.g., Tetracycline, Chloramphenicol, Gentamicin): For abrasions, post-FB removal, chemical burns, prophylaxis in penetrating injury.
• Cycloplegic Drops (e.g., Atropine, Homatropine): For pain relief (ciliary spasm) in abrasion, keratitis, uveitis, chemical burns.
• Systemic Analgesia (Paracetamol, NSAIDs, Opioids).
• Systemic Antiemetics (if needed for penetrating injury).
• Tetanus Toxoid booster / Tetanus Immunoglobulin (TIG) as indicated.
• Systemic Antibiotics (for penetrating injuries, orbital fractures - specialist decision).

Monitoring

Follow up abrasions daily until healed. Monitor for signs of infection. Close monitoring required after any significant trauma by specialist.