Wilderness and Rescue Medicine 7th Edition Jeffrey Isaac, PA-C and David E. Johnson, MD

Wilderness and Rescue Medicine 196

movements, might be uncomfortable, but are fully intact. There will be no evidence of blood behind the cornea (hyphema), and the patient will not report a headache. Signs and symptoms indicating a more serious condition include clouding of the cornea, per- sistent visual disturbances, severe headache, or hyphema. Extraocular movements (EOMs) may be inhibited or very painful. The pupils may not react equally to light. Lid swelling may be severe. These signs and symptoms should prompt early evacuation.

Foreign Body Injury Sand or other debris that contacts the conjunctiva causes immediate irritation, redness, and tearing. Onset is usually abrupt, and the cause is often obvious. The easiest and least traumatic way to remove something from the eye is by irrigation with water. The simplest methods are to have the patient immerse his or her face in clean water and blink the eye, or to irrigate with your water bottle. If the patient continues to have the foreign body sensation, you will need to examine the conjunctiva. Gently pull the lids away from the eye and use a bright light while the patient looks in all directions. The most common location of a foreign body is under the upper lid. If you find something, use a wet cotton swab or corner of a gauze pad to lift it off the membrane. If the object is imbedded in the conjunctiva or cornea, and resists your efforts to remove it, leave it alone. Imbedded foreign bodies require medical atten- tion. Patch the eye if safe to do so, and plan to walk out. Beware of using a patch in situations where impaired vision could be dangerous, and don’t leave it on for more than 24 hours.

Red Eye

General Principles

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Serious (Red Flags): • Vision impaired • EOM impaired • Unequal pupils • Hyphema • Severe eyelid swelling • Penetrating foreign body • Severe headache

hyphema

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Traumatic uveitis

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Treatment of Red Eye The generic treatment for conjunctival irritation includes systemic pain medications, lubricat- ing eye drops, and protective glasses or goggles. Antibiotic eye drops, or ointment is applied when infection is present or anticipated. An eye patch is used only when extraoccular movements will cause further harm, such as with a penetrating foreign body. A topical anesthetic, such as tetracaine or lido- caine, can be used by trained practitioners during eye examinations and foreign body removal. One or two drops will numb the conjunctiva and cor- nea for up to an hour. These anesthetics should not be used for routine pain relief or treatment. They could mask the development of a severe con- dition or allow the patient to cause further injury without realizing it.

A subconjunctival hematoma is blood trapped under the conjunctival membrane on the surface of the eye. It is usually not serious. The cornea is surprisingly tough but neurologi- cally sensitive. Its outer surface can be scratched by a foreign body, branch, fingernail, or wind- blown ice crystals. Corneal abrasion can cause considerable pain and inflammation, making the patient feel like something is in the eye.