Ocular Trauma and Emergencies
Core concepts
Know the initial assessment of ocular trauma: ABCs, visual acuity, pupillary reaction, and a systematic exam. Understand chemical injury (alkali worse than acid), penetrating trauma, hyphaema, and orbital fractures. Learn the principles of irrigation, foreign body removal, and the role of imaging.
Know the red flags: relative afferent pupillary defect, severe pain, vision loss, and a flat anterior chamber. Understand the management of hyphaema (bed rest, avoid aspirin, monitor IOP) and the risk of rebleed.
Traps
- Missing a penetrating injury in a patient with a small wound.
- Underestimating alkali injury (continue irrigation).
- Overlooking an intraocular foreign body.
- Not checking for an RAPD in trauma.
Rule of thumb
Chemical injury = immediate copious irrigation; and any suspected penetrating injury needs imaging and urgent ophthalmology review.
Worked example
A patient with alkali splash to the eye. Immediate irrigation with saline for at least 30 minutes, check pH, and refer urgently. Alkali penetrates deeper than acid and can cause severe damage.