Ocular trauma, which occurs in many different circumstances and by a variety of mechanisms, is an important cause of avoidable severe visual impairment at all ages but particularly in young adult males and is the leading cause of monocular blindness in the United States. Thorough but safe clinical assessment, supplemented when necessary by imaging, is crucial to effective management. Ocular damage and the possible need for early assessment by an ophthalmologist need to be borne in mind in the assessment of any patient with mid-facial injury.
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1. CONJUNCTIVAL & CORNEAL FOREIGN BODIES
If a patient complains of “something in my eye” and gives a consistent history, a foreign body is usually present on the cornea (eFigure 7–72) or under the upper lid even though it may not be visible. Visual acuity should be tested before treatment is instituted, to assess the severity of the injury and as a basis for comparison in the event of complications.
Corneal rust stain from iron foreign body (arrow). (From James J Augsburger and Zélia M Corrêa. Reproduced, with permission, from Riordan-Eva P, Augsburger JJ. Vaughan & Asbury’s General Ophthalmology, 19th ed. McGraw-Hill, 2018.)
After a local anesthetic (eg, proparacaine, 0.5%) is instilled, the eye is examined with a slit lamp or with a hand flashlight, using oblique illumination, and loupe. Corneal foreign bodies may be made more apparent by the instillation of sterile fluorescein. They are then removed with a sterile wet cotton-tipped applicator or hypodermic needle. Bacitracin-polymyxin ophthalmic ointment should be instilled. It is not necessary to patch the eye. All patients need to be advised to return promptly for reassessment if there is any increase in pain, redness, or impairment ...