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ophtho.ocular-trauma.core.v1PRODUCTION
ophtho.ocular-trauma.core.v1

Acute ocular trauma (open-globe / orbital emergency triage)

general_internal_medicineacuteadultpediatric
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12/12 authored

Canonical 12-phase frame with authored status for this dossier.

Current phase

Frame

Detailed

Frame acute ocular trauma as a TIME-CRITICAL triage problem with three findings that override normal sequencing: (1) chemical/alkali splash → irrigate FIRST before anything; (2) open/ruptured globe → STOP, rigid shield, no pressure/pad, NPO, OR; (3) orbital compartment / retrobulbar haemorrhage → immediate bedside lateral canthotomy + cantholysis BEFORE imaging. This engine OWNS the trauma triage + routing; definitive globe/orbit/canalicular surgery is recognised then routed OUT by engine_id (AAO PPP Ocular Trauma; Wills Eye Manual). It is the reciprocal routing target of ophtho.corneal-abrasion.core.v1 and ophtho.acute-red-eye.core.v1.

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trauma scope confirmed; the three sequence-overriding emergencies primed; definitive-surgery concerns flagged for route-out

Patient inputs (15)

Restricted vertical gaze + nausea/vomiting/bradycardia in a child after blunt orbital trauma = white-eyed trapdoor blowout with muscle entrapment + oculocardiac reflex — a 24-48 h surgical urgency, not a head injury (Bera J Maxillofac Oral Surg 2021 PMID 35400913; Dunphy BMJ Case Rep 2019 PMID 30948403)

Documented best acuity in EACH eye (light perception at minimum) is the mandatory medico-legal + prognostic baseline and a primary Ocular Trauma Score input — except a chemical burn where irrigation precedes it (Kuhn OTS; Coelho Ophthalmologica 2022 PMID 35196665)

Sickle trait/disease catastrophically worsens hyphema — sickled cells obstruct trabecular outflow → refractory IOP and optic-nerve loss; AVOID carbonic-anhydrase inhibitors / hyperosmotics that worsen sickling (Gharaibeh Cochrane 2013 PMID 24302299)

Mechanism sets the pre-test prior and the imaging path: high-velocity metal grinding/hammering → IOFB/occult rupture (CT, never MRI if metallic); blunt → blowout/hyphema/commotio; chemical → irrigate-first emergency (Kuhn BETT; Durrani Clin Ophthalmol 2021 PMID 34040343)

A chemical/alkali splash overrides all sequencing — irrigate copiously to a neutral, stable pH BEFORE acuity/history; alkali penetrates (liquefactive necrosis) far worse than acid and is the true ocular emergency (Soleimani Clin Ophthalmol 2020 PMID 32982161)

Anterior-chamber blood layering (microhyphema → grade IV/8-ball), pupil shape (peaked = occult rupture), and rebleed risk drive the hyphema pathway and the sickle/IOP escalation (Gharaibeh Cochrane 2013 PMID 24302299)

Seidel-positive aqueous stream, peaked/teardrop pupil, uveal/vitreous prolapse, full-thickness laceration, shallow/flat chamber, ↓IOP, low acuity = open globe — STOP examining, rigid shield, NO pressure/pad, NPO, route to OR (AAO PPP Ocular Trauma; Coelho Ophthalmologica 2022 PMID 35196665)

Low IOP suggests occult open globe (do not tonometer-press a suspected ruptured globe); high IOP with proptosis = orbital compartment syndrome (→ canthotomy) or hyphema with secondary glaucoma — drives divergent emergencies (Wills Eye Manual; Gharaibeh Cochrane 2013 PMID 24302299)

Proptosis + a tense orbit + RAPD + ↑IOP + ophthalmoplegia + pain = orbital compartment syndrome / retrobulbar haemorrhage — a CLINICAL diagnosis mandating immediate lateral canthotomy + inferior cantholysis BEFORE imaging (vision lost in ~60-120 min) (AAO PPP Ocular Trauma)

Tetanus prophylaxis is indicated for any open-globe / penetrating / contaminated ocular or adnexal wound (AAO PPP Ocular Trauma; CDC)

A child who cannot cooperate may need exam under sedation/anaesthesia; an inconsistent/implausible mechanism mandates a non-accidental-injury safeguarding assessment (Bera J Maxillofac Oral Surg 2021 PMID 35400913)

Thin-slice orbital CT (NEVER MRI if a metallic foreign body is possible) for occult rupture, IOFB localisation, orbital fracture and retrobulbar haemorrhage — but canthotomy for orbital compartment is clinical and precedes imaging (Durrani Clin Ophthalmol 2021 PMID 34040343; Isik/Kuhn 2024 PMID 38752917)

Anticoagulant/antiplatelet use raises hyphema-rebleed and retrobulbar-haemorrhage risk and severity and modifies admission/reversal decisions (Gharaibeh Cochrane 2013 PMID 24302299)

Injury to a sole-seeing eye (or fellow-eye amblyopia) raises every threshold for protection, imaging speed and ophthalmology escalation (AAO PPP Ocular Trauma)

Drug-safety gating — acetazolamide, antifibrinolytics, fluoroquinolones, mannitol and antiemetic choices change in pregnancy (AAO PPP Ocular Trauma)

* = hard-required. Engine cannot meaningfully run until these are filled.

Severity triggers (8)

8 need judgement
  • informationallife_threateningopen_globe_rupture_penetrating_injury
    Seidel-positive aqueous stream, peaked/teardrop pupil, uveal/vitreous prolapse, full-thickness corneal/scleral laceration, shallow/flat anterior chamber, ↓IOP, or unexplained low/no acuity after a sharp/high-velocity mechanism (AAO PPP Ocular Trauma; Coelho Ophthalmologica 2022 PMID 35196665)
    Trigger could not be auto-evaluated — needs clinician judgement.
  • informationallife_threateningchemical_alkali_burn_irrigate_now_before_anything
    Chemical / alkali / acid ocular splash — pain, blepharospasm, conjunctival/limbal blanching, corneal haze; alkali penetrates (liquefactive necrosis) far worse than acid (Soleimani Clin Ophthalmol 2020 PMID 32982161)
    Trigger could not be auto-evaluated — needs clinician judgement.
  • informationallife_threateningorbital_compartment_retrobulbar_haemorrhage_canthotomy
    Proptosis, a tense "tight" orbit, ↑IOP, RAPD, ophthalmoplegia and pain after orbital trauma/retrobulbar bleed — orbital compartment syndrome (AAO PPP Ocular Trauma; Wills Eye Manual)
    Trigger could not be auto-evaluated — needs clinician judgement.
  • informationallife_threateningintraocular_or_orbital_foreign_body
    High-velocity metal grinding/hammering/drilling/blast mechanism with an entry wound, occult low acuity, or vitreous/retinal signs — suspected intraocular/orbital foreign body (Durrani Clin Ophthalmol 2021 PMID 34040343; Isik/Kuhn 2024 PMID 38752917)
    Trigger could not be auto-evaluated — needs clinician judgement.
  • informationalseverehyphema_high_iop_or_sickle_or_rebleed
    Traumatic hyphema with elevated IOP, large/8-ball clot, sickle-cell trait/disease, anticoagulation, or rebleed (peak days 2-5) (Gharaibeh Cochrane 2013 PMID 24302299)
    Trigger could not be auto-evaluated — needs clinician judgement.
  • informationalseverewhite_eyed_blowout_entrapment_paediatric_oculocardiac
    Child/young adult with blunt orbital trauma, minimal external signs, restricted vertical gaze, and nausea/vomiting/bradycardia (oculocardiac reflex) — white-eyed trapdoor blowout with muscle entrapment (Bera J Maxillofac Oral Surg 2021 PMID 35400913; Dunphy BMJ Case Rep 2019 PMID 30948403)
    Trigger could not be auto-evaluated — needs clinician judgement.
  • informationalseveretraumatic_optic_neuropathy
    Post-traumatic visual loss with a relative afferent pupillary defect and a relatively quiet eye, no decompressible compressive haematoma on imaging (Levin Ophthalmology 1999 PMID 10406604)
    Trigger could not be auto-evaluated — needs clinician judgement.
  • informationalmoderatecommotio_retinae_or_traumatic_retinal_detachment
    Blunt globe trauma with grey retinal whitening (commotio retinae / Berlin oedema) or new floaters/field loss — risk of traumatic retinal detachment or macular sequelae (AAO PPP Ocular Trauma)
    Trigger could not be auto-evaluated — needs clinician judgement.

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Recommended regimen

Acute ocular trauma — injury-stratified initial management (definitive surgery routed OUT)
axis: ocular_trauma_injury_stratifiedstep 1 - Step 1 — Chemical/alkali burn: IMMEDIATE copious irrigation BEFORE anything else
Selected step "Step 1 — Chemical/alkali burn: IMMEDIATE copious irrigation BEFORE anything else" — Any chemical / alkali / acid ocular splash — irrigation precedes history, acuity, and every pharmacologic step; continue to a neutral, stable pH
  • immediate_copious_irrigation_to_neutral_stable_pH
    first line
    emergency_decontamination
    triggers: chemical_exposure, alkali_splash, acid_splash
    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
    add on
    procedure_adjunct
    triggers: blepharospasm_preventing_irrigation
    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).

ed playbook — drug actions (4)

  1. 1. copious irrigation to neutral stable pH (chemical)
    litres until pH neutral + stable • ocular lavage • continuous then recheck pH
    trigger: Any chemical/alkali/acid splash — precedes everything (Soleimani Clin Ophthalmol 2020 PMID 32982161)
    Time-to-irrigation is the dominant modifiable prognostic factor; alkali far worse than acid
  2. 2. IV vancomycin + ceftazidime (open globe)
    rxcui 11124
    15-20 mg/kg + 1-2 g • IV • q8-12h + q8h
    trigger: Any open-globe sign — endophthalmitis prophylaxis (Durrani Clin Ophthalmol 2021 PMID 34040343; Abouammoh PMID 28771946)
    Covers Bacillus/gram-positive + gram-negative; suspected endophthalmitis 3.7%→1.7%
  3. 3. ondansetron + tetanus toxoid (open globe)
    rxcui 26225
    4-8 mg IV / 0.5 mL IM • IV / IM • q8h PRN / once
    trigger: Open globe — prevent Valsalva uveal/vitreous expulsion; wound tetanus prophylaxis (AAO PPP Ocular Trauma)
    Antiemesis protects the open wound; tetanus for contaminated/penetrating injury
  4. 4. atropine + aminocaproic acid + timolol (hyphema, sickle-aware)
    rxcui 1223
    1% BID-TID / 50 mg/kg q4h / 0.5% BID • ophthalmic / PO / ophthalmic • per agent
    trigger: Layered AC blood, globe closed; timolol if ↑IOP (sickle-safe), acetazolamide ONLY if non-sickle (Gharaibeh Cochrane 2013 PMID 24302299)
    Cycloplegia + antifibrinolytic rebleed reduction + sickle-safe IOP control

Auto-drafted A&P note

ed

Subjective

- Possible entry pathways: 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); 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).

Objective

- No vitals, labs, or imaging entered for this encounter.

Assessment

**Acute ocular trauma (open-globe / orbital emergency triage)** (ophtho.ocular-trauma.core.v1).
Phenotype framing: Terminal trauma differential with explicit pivots — OPEN GLOBE / RUPTURE / PENETRATION (Seidel+ + peaked pupil + uveal prolapse + ↓IOP + low acuity pivot) vs CHEMICAL BURN (splash history + pH abnormal + limbal blanching/ischaemia pivot — alkali worse than acid) vs ORBITAL COMPARTMENT / RETROBULBAR HAEMORRHAGE (proptosis + tight orbit + ↑IOP + RAPD pivot) vs TRAUMATIC HYPHEMA (layered AC blood + rebleed/sickle pivot) vs ORBITAL-WALL BLOWOUT — esp. paediatric white-eyed trapdoor (restricted vertical gaze + nausea/bradycardia + minimal external signs pivot) vs INTRAOCULAR/ORBITAL FOREIGN BODY (high-velocity metal + occult entry + CT-dense pivot) vs TRAUMATIC OPTIC NEUROPATHY (vision loss + RAPD + quiet eye + no compressive lesion pivot) vs COMMOTIO RETINAE (blunt + grey retinal whitening + intact globe pivot) vs LID/CANALICULAR LACERATION (medial-canthal wound + lacrimal involvement pivot). Distinguish from simple corneal abrasion, non-traumatic red eye, microbial keratitis. Co-existence flagged (e.g., hyphema + occult rupture; abrasion overlying open globe).
Scope: Frame acute ocular trauma as a TIME-CRITICAL triage problem with three findings that override normal sequencing: (1) chemical/alkali splash → irrigate FIRST before anything; (2) open/ruptured globe → STOP, rigid shield, no pressure/pad, NPO, OR; (3) orbital compartment / retrobulbar haemorrhage → immediate bedside lateral canthotomy + cantholysis BEFORE imaging. This engine OWNS the trauma triage + routing; definitive globe/orbit/canalicular surgery is recognised then routed OUT by engine_id (AAO PPP Ocular Trauma; Wills Eye Manual). It is the reciprocal routing target of ophtho.corneal-abrasion.core.v1 and ophtho.acute-red-eye.core.v1.

No severity triggers fired against current inputs.

Plan

Regimen axis: **Acute ocular trauma — injury-stratified initial management (definitive surgery routed OUT)** — step "Step 1 — Chemical/alkali burn: IMMEDIATE copious irrigation BEFORE anything else".
1. immediate_copious_irrigation_to_neutral_stable_pH (emergency_decontamination, first line) — 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.
2. topical_anaesthetic_for_irrigation_exam_only_never_dispensed (procedure_adjunct, add on) — 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).

Setting playbook (ed) — In minutes: irrigate any chemical burn FIRST; recognise + shield (never pad/pressure) an open globe with NPO + IV antibiotics + antiemetic + tetanus; decompress orbital compartment by immediate lateral canthotomy BEFORE imaging; grade + start the hyphema bundle (sickle-aware); CT (not MRI) for IOFB; route definitive surgery by engine_id (AAO PPP Ocular Trauma; Wills Eye Manual; Soleimani Clin Ophthalmol 2020 PMID 32982161)
3. copious irrigation to neutral stable pH (chemical) litres until pH neutral + stable ocular lavage continuous then recheck pH — Any chemical/alkali/acid splash — precedes everything (Soleimani Clin Ophthalmol 2020 PMID 32982161) (Time-to-irrigation is the dominant modifiable prognostic factor; alkali far worse than acid)
4. IV vancomycin + ceftazidime (open globe) 15-20 mg/kg + 1-2 g IV q8-12h + q8h — Any open-globe sign — endophthalmitis prophylaxis (Durrani Clin Ophthalmol 2021 PMID 34040343; Abouammoh PMID 28771946) (Covers Bacillus/gram-positive + gram-negative; suspected endophthalmitis 3.7%→1.7%)
5. ondansetron + tetanus toxoid (open globe) 4-8 mg IV / 0.5 mL IM IV / IM q8h PRN / once — Open globe — prevent Valsalva uveal/vitreous expulsion; wound tetanus prophylaxis (AAO PPP Ocular Trauma) (Antiemesis protects the open wound; tetanus for contaminated/penetrating injury)
6. atropine + aminocaproic acid + timolol (hyphema, sickle-aware) 1% BID-TID / 50 mg/kg q4h / 0.5% BID ophthalmic / PO / ophthalmic per agent — Layered AC blood, globe closed; timolol if ↑IOP (sickle-safe), acetazolamide ONLY if non-sickle (Gharaibeh Cochrane 2013 PMID 24302299) (Cycloplegia + antifibrinolytic rebleed reduction + sickle-safe IOP control)

Non-pharmacologic actions:
- Rigid eye shield (taped to bony rims), NO pad, NO pressure, NO tonometry/manipulation, NPO for a suspected open globe (AAO PPP Ocular Trauma)
- Immediate lateral canthotomy + inferior cantholysis at the bedside for orbital compartment syndrome — BEFORE any imaging (Wills Eye Manual)
- Thin-slice orbital CT — NEVER MRI — if a metallic intraocular/orbital foreign body is possible (Durrani Clin Ophthalmol 2021 PMID 34040343)
- Do not remove a protruding penetrating foreign body in the ED; head elevation + activity restriction for hyphema (Gharaibeh Cochrane 2013 PMID 24302299)

AVOID / contraindication checks:
- NEVER pad pressure tonometer or manipulate a suspected open globe rigid shield only NPO (AAO PPP Ocular Trauma)
- Irrigate chemical burn FIRST before history acuity or any drug (Soleimani Clin Ophthalmol 2020 PMID 32982161)
- Orbital compartment canthotomy is clinical and precedes imaging do not wait for CT (AAO PPP Ocular Trauma)
- Acetazolamide and hyperosmotic CONTRAINDICATED in sickle trait or disease hyphema use timolol (Gharaibeh Cochrane 2013 PMID 24302299)
- CT orbit NEVER MRI if metallic intraocular foreign body suspected (Durrani Clin Ophthalmol 2021 PMID 34040343)
- Antifibrinolytic individualise slower hyphema clearance and nausea avoid in pregnancy DIC (Gharaibeh Cochrane 2013 PMID 24302299)
- No topical drops or ointment onto an open globe systemic antibiotics only (AAO PPP Ocular Trauma)
- No megadose steroid or routine canal decompression as standard for traumatic optic neuropathy (Levin Ophthalmology 1999 PMID 10406604)

Monitoring

Regimen monitoring:
- open globe endophthalmitis watch pain out of proportion hypopyon vision drop (Durrani Clin Ophthalmol 2021 PMID 34040343)
- hyphema daily IOP and rebleed watch peak days 2-5 worse with sickle or anticoagulation (Gharaibeh Cochrane 2013 PMID 24302299)
- chemical burn serial pH epithelial healing limbal perfusion IOP (Soleimani Clin Ophthalmol 2020 PMID 32982161)
- paediatric white eyed blowout persistent oculocardiac reflex or restriction re-refer within 24-48h (Bera J Maxillofac Oral Surg 2021 PMID 35400913)
- post open globe sympathetic ophthalmia fellow eye counsel and monitor (AAO PPP Ocular Trauma)

Setting (ed) monitoring:
- Re-check pH after chemical irrigation until neutral and STABLE (Soleimani Clin Ophthalmol 2020 PMID 32982161)
- Recheck for occult rupture before discharging any periocular trauma (a benign surface finding never excludes rupture) (AAO PPP Ocular Trauma)
- Persistent oculocardiac reflex / vertical-gaze restriction in a child → urgent maxillofacial/ophthalmology, do not label "head injury" (Dunphy BMJ Case Rep 2019 PMID 30948403)

Follow-up plan: 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.
- Close-out criterion: sympathetic-ophthalmia / traumatic-glaucoma / LSCD / eye-protection / NAI follow-up documented; reciprocal handback made if applicable

Monitoring phase: Open globe pre-/post-op: watch for endophthalmitis (pain out of proportion, hypopyon, worsening vision — Durrani Clin Ophthalmol 2021 PMID 34040343 → route ophtho.endophthalmitis.core.v1) and sympathetic ophthalmia counselling. Hyphema: daily IOP + rebleed watch (peak rebleed days 2-5, worse with sickle/anticoagulation), clearance time (longer on aminocaproic acid — Gharaibeh Cochrane 2013 PMID 24302299). Chemical burn: serial pH, epithelial healing, IOP, limbal perfusion (Soleimani Clin Ophthalmol 2020 PMID 32982161). Blowout entrapment: do not let the white-eyed trapdoor sit — re-image / re-refer if persistent oculocardiac reflex/restriction (Bera J Maxillofac Oral Surg 2021 PMID 35400913).

Disposition

Current setting: ed — In minutes: irrigate any chemical burn FIRST; recognise + shield (never pad/pressure) an open globe with NPO + IV antibiotics + antiemetic + tetanus; decompress orbital compartment by immediate lateral canthotomy BEFORE imaging; grade + start the hyphema bundle (sickle-aware); CT (not MRI) for IOFB; route definitive surgery by engine_id (AAO PPP Ocular Trauma; Wills Eye Manual; Soleimani Clin Ophthalmol 2020 PMID 32982161)

Disposition criteria:
- Admit + emergent OR for open globe / IOFB / orbital compartment post-canthotomy / high-grade chemical burn / entrapment blowout (AAO PPP Ocular Trauma)
- Hyphema: admit vs close outpatient by grade / sickle / anticoagulation / rebleed-risk / compliance (Gharaibeh Cochrane 2013 PMID 24302299)
- Simple lid laceration sparing margin/canaliculus, minor commotio with intact globe → repair/observe + next-day ophthalmology (Wills Eye Manual)

Escalation triggers (move to higher acuity):
- Open globe / orbital compartment / sight-threatening chemical burn / white-eyed blowout with entrapment → emergent ophthalmology + OR, route by engine_id (AAO PPP Ocular Trauma)
- Suspected post-traumatic endophthalmitis → route ophtho.endophthalmitis.core.v1 (Durrani Clin Ophthalmol 2021 PMID 34040343)
- Contaminated wound with proptosis/fever → orbital cellulitis, route ophtho.orbital-cellulitis.core.v1 (AAO PPP Ocular Trauma)

Earlier-Return Triggers

Return-precaution thresholds (watch for):
- [LIFE_THREATENING] Seidel-positive aqueous stream, peaked/teardrop pupil, uveal/vitreous prolapse, full-thickness corneal/scleral laceration, shallow/flat anterior chamber, ↓IOP, or unexplained low/no acuity after a sharp/high-velocity mechanism (AAO PPP Ocular Trauma; Coelho Ophthalmologica 2022 PMID 35196665)
- [LIFE_THREATENING] Chemical / alkali / acid ocular splash — pain, blepharospasm, conjunctival/limbal blanching, corneal haze; alkali penetrates (liquefactive necrosis) far worse than acid (Soleimani Clin Ophthalmol 2020 PMID 32982161)
- [LIFE_THREATENING] Proptosis, a tense "tight" orbit, ↑IOP, RAPD, ophthalmoplegia and pain after orbital trauma/retrobulbar bleed — orbital compartment syndrome (AAO PPP Ocular Trauma; Wills Eye Manual)

Citations

- 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) [PMID:34040343](https://pubmed.ncbi.nlm.nih.gov/34040343/)
- Cited evidence (PMID 28771946) [PMID:28771946](https://pubmed.ncbi.nlm.nih.gov/28771946/)
- Cited evidence (PMID 24302299) [PMID:24302299](https://pubmed.ncbi.nlm.nih.gov/24302299/)
- Cited evidence (PMID 21249670) [PMID:21249670](https://pubmed.ncbi.nlm.nih.gov/21249670/)
- Cited evidence (PMID 10406604) [PMID:10406604](https://pubmed.ncbi.nlm.nih.gov/10406604/)

Last reconciled with current guidelines: 2026-05-17.
References
  • 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) — PMID:34040343
  • Cited evidence (PMID 28771946) — PMID:28771946
  • Cited evidence (PMID 24302299) — PMID:24302299
  • Cited evidence (PMID 21249670) — PMID:21249670
  • Cited evidence (PMID 10406604) — PMID:10406604