This handout is for acute ocular trauma (open-globe / orbital emergency triage). Your care team identified this based on: eye injury with any open-globe sign — seidel-positive leak, peaked/teardrop pupil, uveal prolapse, full-thickness laceration, low/no acuity, shallow chamber (open-globe emergency — kuhn bett/ots; aao ppp ocular trauma; coelho ophthalmologica 2022 pmid 35196665).
Other reasons your team may use this plan: chemical / alkali / acid splash to the eye — the one true ocular emergency that precedes history and exam: irrigate copiously to neutral stable ph first (soleimani clin ophthalmol 2020 pmid 32982161); periorbital trauma with proptosis, a tense "tight" orbit, ↑iop, rapd, pain, ophthalmoplegia — orbital compartment syndrome / retrobulbar haemorrhage requiring immediate lateral canthotomy before imaging (wills eye manual; aao ppp ocular trauma); high-velocity mechanism — grinding, hammering metal-on-metal, drilling, blast — high intraocular/orbital foreign-body & occult-rupture prior; ct orbit (never mri if metallic) (durrani clin ophthalmol 2021 pmid 34040343; isik/kuhn 2024 pmid 38752917).
Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.
| Medication | Starting dose | How | When | What it does |
|---|---|---|---|---|
| immediate_copious_irrigation_to_neutral_stable_pH | — | — | — | Soleimani Clin Ophthalmol 2020 (PMID 32982161) — chemical burn is an absolute emergency; copious immediate irrigation (litres, until pH neutral AND stable on recheck) limits limbal-stem-cell loss. Alkali (liquefactive penetration) is far worse than acid; time-to-irrigation is the dominant modifiable prognostic factor. |
| topical_anaesthetic_for_irrigation_exam_only_never_dispensed | — | — | — | A single drop of topical anaesthetic enables adequate irrigation/exam; never dispensed for home use (toxic keratopathy). Lid retraction + fornix sweep for particulate alkali (lime). |
Plan: Acute ocular trauma — injury-stratified initial management (definitive surgery routed OUT)
Call 911 or go to the nearest emergency room right away if you have:
Post-trauma long tail + prevention: sympathetic-ophthalmia awareness and fellow-eye monitoring after open globe; traumatic-glaucoma / angle-recession surveillance after hyphema; late retinal-detachment / epiretinal-membrane risk after commotio (→ ophtho.retinal-detachment.core.v1); chemical-burn limbal-stem-cell-deficiency rehabilitation pathway (Iyer BJO 2017 PMID 28407620; Mittal BJO 2015 PMID 26701687); occupational + sport eye-protection counselling (the dominant preventable mechanism); NAI safeguarding follow-through in children; reciprocal handback to ophtho.corneal-abrasion.core.v1 / ophtho.acute-red-eye.core.v1 if trauma excluded and a simple surface diagnosis remains.
Guideline: AAO Preferred Practice Pattern — Ocular Trauma + Wills Eye Manual eye-trauma algorithms + Birmingham Eye Trauma Terminology (BETT) and the Ocular Trauma Score (Kuhn) for classification & visual prognosis + Durrani, Risk Factors for Endophthalmitis Following Open Globe Injuries, Clin Ophthalmol 2021 + Abouammoh, Prophylactic intravitreal antibiotics after open globe repair, Acta Ophthalmol 2017 + Gharaibeh, Medical interventions for traumatic hyphema, Cochrane 2013 + Levin, International Optic Nerve Trauma Study, Ophthalmology 1999 + Bera, paediatric orbital-fracture timing systematic review, J Maxillofac Oral Surg 2021 + Soleimani, Management Strategies of Ocular Chemical Burns, Clin Ophthalmol 2020 (with Roper-Hall / Dua chemical-injury grading)