1 Eye Injuries Temple College EMS Professions

2 Eye Anatomy ScleraChoroid Retina Cornea IrisPupil Lens

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 –Dont 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 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 O 2, 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 O 2 –Assist ventilations gently with BVM –Consider ALS intercept for endotracheal intubation or surgical airway