Emergency War Surgery NATO Handbook: Part IV: Regional Wounds and Injuries: Chapter XXIV: Wounds and Injuries of the Eye

Management: Minor Injuries

United States Department of Defense

Minor ocular injuries which may be handled safely in the division area include laceration of the eyelids, subconjunctival hemorrhage, superficial foreign bodies, and corneal abrasions. Irrigation of the eyes and removal of superficial corneal foreign bodies may be performed under 0.5% Opthaine or Opthetic (Proparacaine hydrochloride 0.5%) or 0.5% Pontocaine (Tetracaine hydrochloride) anesthesia. A sharp-pointed instrument, such as a large needle or eye spud, should be used. The superficial abrasion left after the object is removed is treated by instillation of an antibiotic ointment and patching. If the particles are found to be multiple and more deeply imbedded than has been anticipated, the patient should be evacuated. Foreign bodies should be managed as previously described in the section on examination and diagnosis.

Subconjunctival hemorrhages associated with neither decrease of visual acuity nor blood in the anterior chamber (hyphema) or in the vitreous humor require no treatment. However, thorough ophthalmoscopy through a well-dilated pupil is necessary before returning the patient to duty. If blood is found in the anterior chamber or the vitreous humor, the patient should be placed on bedrest, with elevation of the head, monocular patches applied, and prepared for immediate evacuation.

Contusions of the eyelids and eyeball should likewise be examined carefully. If there is only subcutaneous and subconjunctival hemorrhage, without intraocular hemorrhage or disturbance of vision, the patient can be returned to duty.

Foreign body sensation, aggravated by blinking, and pain referred to the upper lid are characteristically found with corneal abrasion, which is usually a minor, but always painful lesion. Documentation by the use of a fluorescein strip, placed momentarily in the conjunctival fornix, may be diagnostically helpful. The abrasion can often be seen merely by focusing on the anterior corneal surface with +8D and +12D lenses (black numbers) using the conventional direct ophthalmoscope. The inner surface of the upper lid should be carefully examined for the presence of foreign bodies. This may necessitate careful eversion of the upper lid.

The treatment of ordinary corneal abrasions consists of. (1) cycloplegia, using two drops of either scopolamine hydrochloride 0.25-0.5%, cyclopentolate hydrochloride 1-2%, or homatropine hydrobromide 5%; (2) instillation of ophthalmic antibiotic solution or ointment, and (3) application of a tight patch to insure immobility of the eyelid. The patch can usually be discontinued in 24-36 hours, but repatching for another 24-36 hours may be necessary for larger abrasions. Lack of progressive improvement necessitates referral to an ophthalmologist. The use of topical anesthesia for other than facilitating vision testing, examination, or instrumentation is contraindicated. Repeated installation inhibits healing. Topical steroids or steroid antibiotic combinations are likewise contraindicated. Steroids are unnecessary and will cause rapid progression of a dendritic ulcer, including corneal perforation, should this lesion exist or supervene. Fungal superinfection and glaucoma may also result from injudicious use of topical steroids.  

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Operational Medicine 2001

Health Care in Military Settings

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