First Aid for Eye Injuries in War and Disaster

Safety

• Airway. Struggling, obstructed, gasping
• Breathing. Lack of breath sounds or chest rising and falling
• Circulation. No pulse, no heart sounds

• Severe bleeding
  • Stop or slow the bleeding before proceeding.
• Suspected brain or spinal cord injury; paralysis and/or lack of sensation
  • Stabilize the person’s head and spine before moving them.

• Do not remove protruding foreign bodies.
• Shield eye.
• Prevent
  • Touching
  • Rubbing
  • Bumping

First Aid – Eye DO’s

• DO flush with clean water or saline if chemical burn or small debris is suspected.
  • Dilute chemicals and remove loose topical debris.
  • Use copious amounts of clean water or saline water if available. Use > 2 liters for a suspected chemical burn.
  • Have injured person open their eyes and blink frequently but do not try to forcefully open eye.
  • Leave visible debris or foreign bodies in place unless it easily rinses away.

• DO perform a preliminary exam.
  • Vital sign for the eye is vision.
  • Be gentle.
    • Avoid pressure on eye or eyelids.
• DO shield and secure.
  • Protect ocular surface and secure with a rigid barrier for the eye.
  • Apply topical ophthalmic antibiotics if available.
  • Keep eye / lids moist with layer of loosely taped, clean, wet gauze.
  • Use available resources to fully cover eyelids.
    • Styrofoam/paper cup
    • Goggles
    • Sunglasses
  • Secure shield to bony rim around eye using tape or wrap.
    • Shield should rest entirely on facial bones.
    • Do not disrupt protruding foreign body.

• DO seek additional healthcare consultation. (see Triage section)
• DO keep head elevated at 30 degrees.

First Aid – Eye DO NOT’s

• DO NOT put pressure on the eye or touch the eye directly.
• DO NOT attempt to remove foreign bodies.
• DO NOT flush with acid, base, or alcohol.
• DO NOT use non-ophthalmic medications on eye.
• DO NOT use contact lenses.
• DO NOT lift heavy objects or strain.

Triage

• Cause of trauma
  • Blast or explosion?
  • Firearm or other projectile?
  • Blunt impact?
  • Knife or other sharp object?
  • Flying debris?
  • Chemical burn?
  • Was organic matter involved?
• Description of eye injury
  • What does the injury look like?
  • Is the eye intact?
  • Are there any objects in the eye?
  • What color is the eye?
  • Are the eye and/or lids swollen?
  • Are the eyelids damaged?
• Other injuries
  • What other injuries did the person sustain?
  • Is there other facial trauma?
    • Facial bones?
    • Nose?
    • Throat?
  • Is there brain and spinal cord injury?
    • Are they alert to you and their surroundings?
    • Do they understand what is happening?
    • Can they move and feel their head and body?
• Pre-existing health conditions
  • Does the person have any health conditions, for example, diabetes, heart disease, or others?

• Quality. If they usually wear glasses, check vision with glasses on.
  • Is the vision clear, blurry, hazy, red, dim, or other?
  • Do they see any floaters or shadows?
  • If glasses are not available, is vision normal without glasses?
• Perception
  • Can they see light vs. dark?
  • Count fingers?
  • Hand motion in front of their face?
  • The color red?
  • Do they see the same shade of red in both eyes?
• Focus. Obtain a newspaper, book, poster, or something with text on it.
  • What’s the furthest distance from which they can still read the text?
  • Can they read large signs that may be around?
• Change
  • How is their vision compared to what it was before the injury?
  • Is vision getting worse or better?
• Glasses
  • Do they wear glasses or contacts?
  • Are they wearing contacts now?
  • Are the glasses for distance, reading, or both?
  • Do they have their glasses with them?
• Pupils. In a dark or shaded area, shine a bright light such as a phone flashlight in one eye and then the other.
  • Are both pupils the same shape and size?
  • When moving the light from one to the other, do the pupil sizes change equally and at the same time for both eyes?
• Eye movement. Do not test if there is an embedded foreign body in the eye.
  • Can the eyes move all the way up, down, left, right, diagonally, to the middle?

• Vision is rapidly decreasing.
• There is severe pain.
• There is non-stop bleeding.
• There are suspected puncture wounds to the eye.
• There is a suspected intra-ocular foreign body.
• The eye is tense and protruding.
• The eyelids are so damaged they cannot fully cover the eyeball.
• The shape of the eyeball is distorted or shrunken.
• The shape of the pupil is irregular or distorted.

• The eye is no longer intact.
• The eye socket has been fractured causing the eye to be displaced.
• The pressure builds up uncontrollably around the eye tissue. The eye may bulge and be red and/or inflamed. The eye may not move.

Prevention

• Use eye protection. Wear shatterproof goggles or protective glasses.
• Properly use contact lenses. Remember to routinely cleanse or switch out contact lenses.
• Do not touch or rub eyes.
• Seek care early.

• Assess eyeball
• Flush with clean water
• Apply clean wet gauze
• Shield and secure the eye

• Flush with more than 2 liters of clean water
• Shield and secure the eye
• Refer immediately to eye specialist

• Do not remove lodged object from eye
• Flush eye with clean water
• Gently shield and secure the eye
• Refer immediately to eye specialist

• Flush with clean water if dirty
• Shield and secure the eye
• Refer immediately to eye specialist

• Examine eye when neurologically stable
• Shield and secure the eye
• Refer immediately to eye specialist

Video