Safety

The priority is the safety of the injured and the first aid personnel.

1. Remove the person from the danger zone and seek safe shelter.

2. Assess for ABC’s. If needed, start CPR.

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

3. Assess for potential life-threatening injuries and address.

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.

4. Secure the eye.

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

5. Assess mechanism of injury and determine need to transport to nearest health care.

First Aid – Eye DO’s

The first aid response to all eye injuries are similar. Follow these steps.

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.

***Image 1:*** *Flush the eye with clean water*

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.

**Image 2:** Example of medical pad and eye shield

**Image 4:** Shield and secure the eye using makeshift resources

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

First Aid – Eye DO NOT’s

First aid to the eye is NOT similar to first aid for other bodily wounds. Be sure to review the following list to avoid causing further damage.

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

When the injured is safe and the eye is shielded and secure, seek further evaluation and treatment via telephone/online consultation or immediate evacuation. To triage, obtain a basic understanding of the person’s health.

Gather Important Information (History)

If the person is not able to respond, gather history from a witness if available.

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?

Examining eye function

Vision is the vital sign of the eye. Examining eye function may require you to temporarily remove shield from eye. Examine both eyes to compare. Examine vision in each eye separately by covering the other eye with tape, patch or your hand.

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?

Immediate Attention Required. Get expert consultation on the phone now.

While it is best to get professional help for all injuries, the following signs warrant immediate help to save vision for the eye but are secondary to life-threatening injuries. Obtaining the information in the sections above will help decide how to triage these people, and help you communicate the person’s needs to the healthcare professionals.

Seek help immediately if

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.

Evacuation may be necessary to prevent permanent blindness for the following injuries

In addition to telephone consultation, immediate measures should be taken to deliver the injured to a specialty physician and surgeon in order to preserve vision.

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

The best way to avoid eye injury is to take the following precautions.

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.

Case example 1: Bite wound to eyelid