3. MEDICAL EMERGENCIES
3.7 EYE EMERGENCIES
Eye emergencies can be either medical or traumatic. In general they are not life threatening. However, they present serious potential difficulties for the patient. The primary medical emergency involving the eye is glaucoma. Sudden painless loss of vision secondary to arterial embolus is another treatable medical emergency. Eye injuries can be chemical or thermal burns, penetrating or blunt trauma which can result in permanent disfigurement and/or blindness. In addition small foreign particles landing on the surface of the eye can also result in ocular emergencies. Established regional point-of-entry protocols may determine transport to appropriate facility.
ASSESSMENT / TREATMENT PRIORITIES
1. Maintain universal blood and body fluid precautions.
2. Maintain an open airway and assist ventilations as needed. This may include repositioning of the airway, suctioning, or use of airway adjuncts as indicated.
3. If eye injury is the result of blunt and/or penetrating trauma, assume spinal injury and manage appropriately.
4. Obtain appropriate history related to event, including Past Medical History, Medications, Drug Allergies, Substance Abuse or Trauma (i.e., recent head trauma).
5. Depending upon mechanism of injury, the following procedures should be followed:
a. Chemical irritants: Eye(s) should be flushed as soon as possible using copious amounts of water for a period of fifteen (15) minutes with a controlled stream of Sterile Normal Saline, Sterile water or tap water.
b. Blunt Trauma: Both Eyes should be patched and protected.
c. Penetrating Trauma:
- Puncture wound with no impaled object: Both eyes should be patched and protected.
- *If object impaled in the eye. NOTE: Objects penetrating the eye globe should only be removed in-hospital.
d. Thermal Burns: Both eyes should be patched and protected.
6. If patient is unable to close eyelids, moisten eyes with sterile Normal Saline (exception: chemical irritants which need continuous irrigation) to maintain eye integrity. The eye(s) may then be irrigated and covered with moistened gauze pads.
7. Obtain visual history, including use of contact lenses, corrective lenses (glass/plastic), safety goggles.
8. NOTE: As a general rule, EMTs should not attempt to remove contact lenses in patients with eye injuries. However, in certain chemical burn cases, MEDICAL CONTROL may instruct removal of the lenses if patient is unable to do so.**
TREATMENT
BASIC PROCEDURES
1. Maintain universal blood and body fluid precautions.
2. Maintain an open airway and assist ventilations as needed. This may include repositioning of the airway, suctioning, or use of airway adjuncts as indicated.
3. If eye injury is the result of blunt and/or penetrating trauma, assume spinal injury and manage appropriately.
4. Obtain appropriate history related to event, including Past Medical History, Medications, Drug Allergies, Substance Abuse or Trauma (i.e., recent head trauma).
5. Depending upon mechanism of injury, the following procedures should be followed:
a. Chemical irritants: Eye(s) should be flushed as soon as possible using copious amounts of water for a period of fifteen (15) minutes with a controlled stream of Sterile Normal Saline, Sterile water or tap water.
b. Blunt Trauma: Both Eyes should be patched and protected.
c. Penetrating Trauma:
- Puncture wound with no impaled object: Both eyes should be patched and protected.
- *If object impaled in the eye. NOTE: Objects penetrating the eye globe should only be removed in-hospital.
d. Thermal Burns: Both eyes should be patched and protected.
6. If patient is unable to close eyelids, moisten eyes with sterile Normal Saline (exception: chemical irritants which need continuous irrigation) to maintain eye integrity. The eye(s) may then be irrigated and covered with moistened gauze pads.
7. Obtain visual history, including use of contact lenses, corrective lenses (glass/plastic), safety goggles.
8. NOTE: As a general rule, EMTs should not attempt to remove contact lenses in patients with eye injuries. However, in certain chemical burn cases, MEDICAL CONTROL may instruct removal of the lenses if patient is unable to do so.**
9. Initiate transport as soon as possible with or without ALS.
10. Notify receiving hospital.
INTERMEDIATE PROCEDURES
1. Maintain universal blood and body fluid precautions.
2. Maintain an open airway and assist ventilations as needed. This may include repositioning of the airway, suctioning, or use of airway adjuncts as indicated.
3. If eye injury is the result of blunt and/or penetrating trauma, assume spinal injury and manage appropriately.
4. Obtain appropriate history related to event, including Past Medical History, Medications, Drug Allergies, Substance Abuse or Trauma (i.e., recent head trauma).
5. Depending upon mechanism of injury, the following procedures should be followed:
a. Chemical irritants: Eye(s) should be flushed as soon as possible using copious amounts of water for a period of fifteen (15) minutes with a controlled stream of Sterile Normal Saline, Sterile water or tap water.
b. Blunt Trauma: Both Eyes should be patched and protected.
c. Penetrating Trauma:
- Puncture wound with no impaled object: Both eyes should be patched and protected.
- *If object impaled in the eye. NOTE: Objects penetrating the eye globe should only be removed in-hospital.
d. Thermal Burns: Both eyes should be patched and protected.
6. If patient is unable to close eyelids, moisten eyes with sterile Normal Saline (exception: chemical irritants which need continuous irrigation) to maintain eye integrity. The eye(s) may then be irrigated and covered with moistened gauze pads.
7. Obtain visual history, including use of contact lenses, corrective lenses (glass/plastic), safety goggles.
8. NOTE: As a general rule, EMTs should not attempt to remove contact lenses in patients with eye injuries. However, in certain chemical burn cases, MEDICAL CONTROL may instruct removal of the lenses if patient is unable to do so.**
9. Initiate transport as soon as possible with or without Paramedics.
10. Notify receiving hospital.
PARAMEDIC PROCEDURES
1. Maintain universal blood and body fluid precautions.
2. Maintain an open airway and assist ventilations as needed. This may include repositioning of the airway, suctioning, or use of airway adjuncts as indicated.
3. If eye injury is the result of blunt and/or penetrating trauma, assume spinal injury and manage appropriately.
4. Obtain appropriate history related to event, including Past Medical History, Medications, Drug Allergies, Substance Abuse or Trauma (i.e., recent head trauma).
5. Depending upon mechanism of injury, the following procedures should be followed:
a. Chemical irritants: Eye(s) should be flushed as soon as possible using copious amounts of water for a period of fifteen (15) minutes with a controlled stream of Sterile Normal Saline, Sterile water or tap water.
b. Blunt Trauma: Both Eyes should be patched and protected.
c. Penetrating Trauma:
- Puncture wound with no impaled object: Both eyes should be patched and protected.
- *If object impaled in the eye. NOTE: Objects penetrating the eye globe should only be removed in-hospital.
d. Thermal Burns: Both eyes should be patched and protected.
6. If patient is unable to close eyelids, moisten eyes with sterile Normal Saline (exception: chemical irritants which need continuous irrigation) to maintain eye integrity. The eye(s) may then be irrigated and covered with moistened gauze pads.
7. Obtain visual history, including use of contact lenses, corrective lenses (glass/plastic), safety goggles.
NOTE: As a general rule, EMTs should not attempt to remove contact lenses in patients with eye injuries. However, in certain chemical burn cases, MEDICAL CONTROL may instruct removal of the lenses if patient is unable to do so.**
8. Contact MEDICAL CONTROL. Medical Control may order:
a. Topical anesthetic: Tetracaine 1-2 eye drops as needed
b. Use of Morgan lens for eye irrigation.
c. Special consideration: Sudden painless loss of vision: If suspect central retinal artery occlusion in patient with acute non-traumatic, painless loss of vision in one eye (most common in elderly patient): apply vigorous pressure using heel of hand (massage) to affected eye for three(3) to five(5) seconds, then release. The patient may perform this procedure. Repeat as necessary. NOTE: Cardiac (EKG) monitor is required for this procedure (i.e., vagal stimulus: bradycardia). CAUTION: If Tetracaine has been administered, do not apply pressure to eye.
9. Initiate transport as soon as possible.
10. Notify receiving hospital.
*GUIDELINES FOR SECURING IMPALED OBJECT IN AN EYE
1. Place a roll of gauze bandage or folded gauze pads on either side of the impaled object, along the vertical axis of the head. These rolls or pads should be placed so they stabilize the object.
2. Fit a paper or styrofoam cup or other protective cup/cone etc. over the impaled object. The protective cup should not touch the impaled object and it must rest upon the rolls of gauze or gauze pads.
3. Secure the dressings and cup in place with self adherent roller bandage or wrapping of gauze. B>DO NOT secure bandage over the top of the cup.
4. Patch and bandage the uninjured eye to reduce eye movements.
** GUIDELINES FOR REMOVAL OF CONTACT LENSES
CATEGORY A: Removal of soft contact lenses.
1. Pull down the lower eyelid.
2. Gently slide the lens down onto the conjunctiva.
3. Compress the lens between the thumb and index finger using a pinching motion.
4. Remove the lens.
5. Store lens in a container with water or normal saline and label appropriately (i.e., left/right eye and patient's name).
CATEGORY B: Removal of rigid and hard gas permeable lenses.
1. Separate the eyelids such that the lid margins are beyond the top and bottom edges of the lens.
2. Gently press the eyelids down and forward to the edges of the lens.
3. Move the eyelids toward each other, thereby forcing the lens to slide out between them.
4. Store lens in a container with water or normal saline and label appropriately (i.e., left/right eye and patient's name).
5. If lens removal proves difficult: gently move the lens downward from the cornea to the conjunctiva overlying the sclera until arrival in the ED.
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-- by Phyllis A. Balch, James F. Balch - 2nd Edition
-- by Phyllis A. Balch, James F. Balch - 4th Edition
-- by Phyllis A. Balch
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