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Ocular trauma is an important cause of avoidable severe visual impairment at all ages, and it is the leading cause of monocular blindness in young adult men 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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Heath Jeffery
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Rho
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1. CONJUNCTIVAL & CORNEAL FOREIGN BODIES
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If a patient complains of “something in my eye” and gives a consistent history, a foreign body is usually present on the cornea (eFigure 7–71) 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.
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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. The instillation of sterile fluorescein may make corneal foreign bodies more apparent, which 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 of vision.
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Iron foreign bodies usually leave a diffuse rust ring. This requires excision and is best done under local anesthesia using a slit lamp. Caution: Anesthetic drops should not be given to the patient for self-administration.
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If there is no infection, a layer of corneal epithelial cells will line the crater within 24 hours. While the epithelium is defective, the cornea is extremely susceptible to infection. Early infection is manifested by a white necrotic area around the crater and a small amount of gray exudate.
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In the case of a foreign body under the upper lid, a local anesthetic is instilled and the lid is everted by grasping the lashes gently and exerting pressure on the mid portion of the outer surface of the upper lid with an applicator...