Ocular Emergencies and Trauma
Core concepts
Master the trauma ABCs: chemical injury (irrigate immediately with copious saline), penetrating trauma (do not remove foreign bodies, shield the eye), and blunt trauma (hyphema, retinal detachment, globe rupture). Know chemical burns (alkali worse than acid), hyphema management (bed rest, avoid aspirin, monitor for rebleed), and traumatic optic neuropathy. Understand open globe signs (peaked pupil, shallow anterior chamber, Seidel test) and the role of imaging.
Traps
A key trap is alkali vs. acid burns - alkali penetrates deeper and is more severe; irrigate for at least 30 minutes. Another trap is hyphema rebleed - highest risk in first 5 days; avoid NSAIDs. Also know globe rupture - do not apply pressure or check IOP.
Worked example
A patient with a chemical splash to the eye. Rule of thumb: irrigate first, ask questions later - copious saline for at least 30 minutes, check pH, and refer urgently; alkali burns are worse and may need amniotic membrane or surgery.