Mechanism and Emergency Management of Blast Eye/Orbital Injuries

Sabri T Shuker

Disclosures

Expert Rev Ophthalmol. 2008;3(2):229-246. 

In This Article

Triage of Patients with Eye Injuries

On the battlefield or at the detonation site, the casualty should be examined for evidence of obvious signs and symptoms of serious blast injuries, such as pulmonary, head or extremity amputation. If a hidden injury to another organ is suspected, the victim should be referred to a trauma center for initial triage, before concentrating on the eye. In severe injuries, basic and advanced life support is the primary objective until the patient is stabilized. A consultation for visual system evaluation should be prompt and must be triaged among the multiple consultations and ongoing critical care needs required for the individual patient. If neurosurgical concerns prevent pupillary dilation, a comprehensive evaluation of the posterior sclera, retina, choroids, ciliary body and optic nerve head may be compromised.

The eyes are evaluated and checked for functioning efferent/afferent limbs, extraocular movements, gross deformities, globe perforations, blood, chemosis, dystopia, enophthalmos, exophthalmos and telecanthus. For most, eye injuries should be covered immediately by a simple eye patch for protection. No pressure is to be placed on the open globe. Victims with direct eye injury, not associated with other serious head, facial or general injuries, are evacuated to the ophthalmology department.

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