Suspected penetrating eye injuries

1. Do not force eyelids open -pressure on the lids may cause extrusion of ocular contents.
2. Do not attempt to remove a protruding foreign body from the globe.
3. Fast the patient from the time they are seen.
4. Use appropriate analgesia. Consider NSAIDs. If opiates are required consider concurrent antiemetic as vomiting increases intraocular pressure and may cause expulsion of ocular contents. Use ondansetron rather than agents which may precipitate dystonic reactions.
5. Notify ophthalmology for all suspected penetrating eye injuries.
6. After discussion with ophthalmology, image the orbit (X-ray or CT) in cases where an intra-ocular foreign body is suspected.

Signs suggestive of globe perforation

• Severe loss of vision.
• Squashed or distorted appearance to globe
• Ocular contents extruding from globe (iris and retina ö pigmented, vitreous - clear jelly).
• Distorted or peaked pupil.
• Loss of red reflex.
• Relative afferent pupil defect.
• Loss of ocular motility.
• Shallow anterior chamber
• Chemosis -bulging of the conjunctiva.