Ocular Injuries: Emergency Department Strategies - Trauma EXTRA Supplement (Trauma CME)

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Publication Date: October 2023 (Volume 25, Supplement 10)

CME Credits: 4 AMA PRA Category 1 Credits™ and 4 AOA Category 2-B CME credits. CME expires 10/01/2026.

Specialty CME Credits: Included as part of the 4 credits, this CME activity is eligible for 4 Trauma credits, subject to your state and institutional approval.

Authors

Emily Bae

Weill Cornell School of Medicine, New York, NY

Anne Messman, MD, MHPE

Vice Chair of Education, Department of Emergency Medicine; Professor and Associate Dean of Graduate Medical Education, Wayne State University School of Medicine, Detroit, MI

Kaushal Shah, MD, FACEP

Assistant Dean of Academic Advising, Vice Chair of Education, Professor of Clinical Emergency Medicine, Department of Emergency Medicine, Weill Cornell School of Medicine, New York, NY

Peer Reviewers

Jennifer Maccagnano, DO, FACEP, FACOEP

Assistant Professor, NYIT College of Osteopathic Medicine, Old Westbury, NY; Attending Physician, Maimonides Medical Center, Brooklyn, NY

Kelly P. O'Keefe, MD, FACEP

Program Director and Clinical Professor, Florida State University College of Medicine; Emergency Medicine Residency at Sarasota Memorial Hospital, Sarasota, FL

Abstract

Ocular injuries are common in the emergency department, and they are the most frequent cause of noncongenital monocular blindness in children and adults. Systematic evaluation and management of ocular trauma patients will ensure these patients have the best chance for a favorable final visual outcome. This review provides evidence-based recommendations for the diagnosis, treatment, and disposition of patients with traumatic ocular injuries, including retrobulbar hemorrhage, traumatic hyphema, open globe injuries, ocular chemical burns, and corneal abrasions. The use of bedside ultrasound, antibiotics, cycloplegics, steroids, antifibrinolytics, and patching are also discussed.

Introduction

Ocular injuries can be anxiety-provoking for both the patient and the emergency clinician. Traumatic eye complaints account for 3% of all emergency department (ED) visits in the United States,¹where eye injuries are the leading cause of monocular blindness nationwide.^1-3 Eye injuries are also the most common cause of noncongenital unilateral blindness in the United States pediatric population.⁴

Fortunately, most eye injuries are minor and the overwhelming majority are not associated with significant morbidity.⁵ Even most ocular burns tend to be mild and inconsequential in the long term.⁶ In patients with mild injury, pain management and prevention of secondary infection are the mainstays of treatment. On the other hand, the multiply injured patient poses a particular clinical challenge because a proper eye examination may be difficult or impossible. This issue of Emergency Medicine Practice: Trauma EXTRA! reviews best-practice recommendations for the evaluation and treatment of ocular trauma patients based on the available evidence.

Accreditation:

EB Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.