Diagnosis and emergency management of eye injuries*

FB: foreign body; rAPD: relative afferent pupillary defect; IOFB: intraocular foreign body.
* Eye trauma frequently results in more than one injury to the eye.
¶ Vision-threatening condition, emergency treatment and urgent consultation with an ophthalmologist is needed. Refer to UpToDate topics on eye injuries for management of the specific condition.
Δ Tight eyelids are "rock hard" and cannot be opened. A tight globe resists attempts to push it deeper in the orbit (decreased retropulsion). Refer to UpToDate topics on the overview of eye injuries.
◊ Perform orbital CT to evaluate for orbital fracture or globe disruption and consult ophthalmologist for detailed eye examination, including indirect ophthalmoscopy. Other surgical subspecialists may also need to be consulted eg, neurosurgery if CT shows orbital roof fracture or otolarygnology if the fracture extends into a sinus cavity.
§ For patients with normal vision, visual acuity of 20/40 (6/12) or worse after injury. For patients who do not have normal vision at baseline, a decrease of one line or more on the vision chart.
¥ Consult ophthalmologist for detailed eye examination, including indirect ophthalmoscopy.
‡ Consult ophthalmology or plastic surgery for repair.