Ocular Trauma - Emergency Medicine Revision
Introduction
Ocular trauma ranges from minor eyelid and corneal injuries to vision‑threatening globe rupture, orbital compartment syndrome and injuries that accompany major trauma.
Emergency clinicians must follow usual trauma priorities (ABCDE), rapidly identify sight‑threatening features, initiate immediate, sight‑preserving measures, and arrange appropriate imaging, timely ophthalmology input and follow‑up.
National resources for ED practice include NICE head‑injury guidance for overlapping red flags (NICE NG232), RCEM guidance on minor‑injury services and poisoning management, and TOXBASE/NPIS and GOV.UK chemical hazard pages for agent‑specific advice.
Triage and initial priorities
- Apply ABCDE resuscitation principles first when ocular injury accompanies major trauma; stabilise airway, breathing and circulation before detailed eye assessment (Resuscitation Council UK; NICE NG232).
- Once the patient is haemodynamically stable, perform a focused eye assessment:
- Record best possible visual acuity for each eye separately.
- Check pupils (size and reactivity) and test for a relative afferent pupillary defect (RAPD) using the swinging‑flashlight test.
- Inspect externally for lid lacerations, proptosis, globe position, visible foreign bodies and orbital emphysema.
- Assess the red reflex.
- Protect a suspected ruptured globe with a rigid eye shield (not a pressure patch); keep the patient nil by mouth, give analgesia and antiemetic to avoid Valsalva, and arrange urgent ophthalmology.
- For chemical exposures, begin immediate, copious irrigation at triage - do not wait for specialist advice (consult...