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Emergency Eye Care - An Eye-Opener for Eye Emergencies

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Emergency eye care in the emergency department is important for treating alarming pathologies and accidents in the eye. Continue reading to know more.

Written by

Dr. Kayathri P.

Medically reviewed by

Dr. Shachi Dwivedi

Published At March 20, 2023
Reviewed AtMarch 20, 2023

Introduction

The eye is a specialized sense organ used for seeing and visualizing things and processing information through visual details. The eye starts to work right from waking up and rests when humans sleep. Humans perceive many things by what they see. An obvious trauma to the eye or if there are any vision changes is considered an emergency, and immediate intervention by the medical team is important. Other emergencies include severe eye pain, blurred vision, a foreign object present in the eye, and burns or other injuries to the eye. Some of the common eye emergencies are listed below:

  1. Trauma.

  2. Foreign body presence.

  3. Burns.

  4. Other infections.

  5. Sudden vision loss.

  6. Acute red eyes.

What Are the Symptoms of an Eye Emergency?

Following are the signs indicating emergency intervention:

  • Severe eye pain with headache or fever.

  • Swelling around the eye.

  • Loss of vision.

  • Bleeding.

  • Loss of peripheral vision.

  • Red or swollen eyes.

  • The blurring of vision.

  • Spots or flashing in the eye.

What Are the Common Traumatic Eye Emergencies?

Any accident or trauma to the eye can result in serious complications that can even lead to vision loss. Trauma to the eyes can be sharp or blunt and can result in damages ranging from a laceration to fractures.

  • Blow-Out Fracture: A punch on the eye with a fist and squash ball can cause a blow-out fracture. It can cause pain, extreme pain on vertical movement, diplopia, swelling of the eyelid, and crepitus when nose blowing. Head injury, if any, has to be assessed immediately in the ED (emergency department), and referrals have to be made accordingly. A thorough ophthalmological examination, along with additional investigations like a CT (computed tomography), may be required.

  • Lid Laceration: Lacerations involving the eye margin other than the superficial skin will require immediate ophthalmologic referral. The physician will find out the cause, nature, and severity of the injury. Penetration into the lid or orbit will be assessed. A superficial ocular examination will be carried out to assess for conjunctival laceration or penetration. Further examinations like dilated fundus examination, an orbital X-ray, and a computerized tomography scan (CT) will be done to assess the extent of the injury. All wounds require tetanus prophylaxis (vaccination against tetanus) immediately after admission. First aid will be done in the hospital, and any foreign bodies present in the eye will be examined. Referral to ophthalmologists will be made in severe cases like a ruptured globe of the eye, an intraorbital foreign body, possible damage to the nasolacrimal drainage system, distorted shape or anatomy, and in cases of full-thickness laceration.

  • Ocular Trauma: Ocular trauma can be sharp or blunt depending on the speed and cause of injury. Ocular trauma can be caused due to small projectiles in high velocity, causing a penetrating injury.

  • Blunt Trauma: Blunt injuries usually result in a closed globe injury and the ruptured globe. Blunt trauma can damage the intraocular contents of the eye, and it can, in turn, affect the thin orbital bone. Affected individuals are assessed for edema, rupture, eye movements, and visual acuity. A slit lamp examination is followed to identify rupture if any is present. In suspected orbital fracture cases, a CT will be required. Urgent ophthalmology referral is necessary in cases of orbital wall fracture, intraocular hemorrhage, and the ruptured globe.

  • Sharp Trauma: All types of penetrating trauma will require an urgent referral to the ophthalmologist.

What Will Happen if There Is Foreign Body Present in the Eye?

Corneal Foreign Body: Any penetration of a foreign body into the cornea or retained foreign body in the cornea will require immediate ophthalmologic referral. Retained foreign objects can result in infections. Metallic foreign bodies can lead to rust ring formation in the eye that will cause inflammation and corneal epithelial defect. Occupations involving high-speed motor drills that are done without eye protection can result in penetrating scleral or corneal injuries. The physician will evaluate for foreign bodies through slit lamp examination. Rust rings will be removed by the emergency physician or specialist.

What Are the Common Emergencies Pertaining to Burns in the Eye?

  • Chemical Burns: Chemical burns require immediate ophthalmological intervention. Nature of the chemical exposure and the time lapsed after exposure is to be reported immediately in the ED. Acids and alkalis can harm the eye extensively, and examples of such acids are car battery fluid, toilet, and pool cleaners, and alkalis are lime, drain cleaner, oven cleaner, and ammonia. It can cause vascular blanching at the limbus, and the eye has to be irrigated immediately by medical personnel. The pH of the chemical is assessed using universal indicator paper.

  • Flash Burns: Occupational injuries can cause flash burns from electric arc welding sun lamp use without following eye protection measures. They can produce intense pain, tearing, redness, and blepharospasm (abnormal eyelid contraction).

What Are the Possible Causes of Acute Red Eyes?

Many reasons are there to cause red eyes in an individual. Some of them are:

  • Conjunctivitis: Inflammation irritation of the conjunctiva.

  • Subconjunctival Hemorrhage: Bleeding present under the conjunctiva.

  • Blepharitis: Generalized inflammation of the eyelids.

  • Ectropion: Exposed conjunctival ac with lids turning outwards.

  • Entropion: Eyelids abrading cornea with lids turning inwards.

What Can Cause Sudden Vision Loss?

Sudden vision loss can be due to many reasons. Some of the underlying pathologies are transient ischemic attacks, central retinal vein occlusion, central retinal artery occlusion, optic neuritis, and retinal detachment. These have to be managed by specialists, along with neurological opinion. These, if left untreated, can lead to permanent blindness.

How to Prevent Eye Injury?

  • Using protective eyewear in places of potential incidence of eye injury.

  • Following appropriate safety and precautionary measures while handling chemicals.

  • Do not rub or press the eye in case of foreign object entry or chemical exposure.

  • Wear protective clothing while handling chemicals.

  • Keep children away from sharp objects and chemicals.

Conclusion:

The eye is one of the important organs, and any abnormal changes or sudden injuries should be reported to the clinic immediately. Delaying a symptom or injury can lead to serious complications. Occupational injuries can be prevented by following appropriate safety measures.

Dr. Shachi Dwivedi
Dr. Shachi Dwivedi

Ophthalmology (Eye Care)

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