Blunt Trauma/Perforating Eye Injury/Foreign Body

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Establish the cause to determine the type of injury and whether there is penetration. 

Clinical presentation

  • Corneal abrasion/laceration with or without an imbedded foreign body.
  • Eye lids may also be involved.

Investigations

  • This is done after the first aid measures 
  • Visual acuity
  • Examine  the  injured  eye  with  slit lamp or magnifier
  • Fluorescein staining to reveal foreign body or corneal laceration
  • Tonometry in blunt injury
  • Fundoscopy in blunt injury or embedded foreign body
  • B scan in embedded foreign body
  • CT Scan in suspected metal foreign body

Non-pharmacological Treatment 

  • Provide first aid measures to the patients as per presentation
  • If no penetration, irrigate the eye with clean water or Ringers Lactate to reduce chemical substance in the eye
  • Remove foreign body if visible with a cotton bud or surgical blade if shallow.

Pharmacological Treatment 

At the primary care: 

Corneal Abrasion: 

A:  chloramphenicol  eye  ointment  1%,  8hourly  to  the  injured  eye  until  no  fluorescein staining  

Steps Guiding Management of Complicated Blunt Trauma 

Complicated blunt trauma is a trauma where the vision is poor, patient’s experiences pain and there  is hyphaema. It is best managed by eye specialist as surgery may be required in the management.  

Table 14.5: Steps guiding management of complicated blunt trauma 

Findings

Action to be taken

No hyphema, normal vision 

Observe 

Hyphema, no pain 

Refer 

No hyphema, normal vision, pain 

Paracetamol, observe for 2 days, refer if pain persist 

Poor vision and pain 

Paracetamol, refer urgently 

Hyphema, pain, poor vision 

Paracetamol, refer urgently