Mechanism and Emergency Management of Blast Eye/Orbital Injuries

Sabri T Shuker

Disclosures

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

In This Article

Identifying Severe Eye Injuries

When time is critical due to handling mass casualties and multisystem major injuries, the primary or secondary eye/orbital injuries are unfortunately likely to remain untreated because of life-saving priorities. In the case of a continuous flow of new casualties in longstanding front-line battle or more than one explosion in one city that exhausts medical resources, eye injuries should not be missed. In a study to determine the type and frequency of ocular injuries in patients with major trauma, 16% of the major trauma cohort had ocular or orbital trauma. Of patients with injuries involving the face, 55% had ocular or orbital injuries.[35]

A gross assessment of the visual acuity should be obtained with the use of light and counting fingers. ‘Near charts' are also helpful for the trauma patient. Therefore, the patient should be examined and primary diagnosis determined. This can only occur and indeed depends on first responders (on all levels) being trained to screen for eye injuries when the mechanism of injuries involves small fast moving objects, such as those that occur in blast or other explosive injuries. Eyes should be checked in triage and emergency units by well-trained staff. However, in certain circumstances emergency room personnel are not properly trained such as when extra hands are needed or when volunteers from other medical units are not familiar with emergency management. This could take place in situations where there is a high influx of severe casualties in a short period of time. The eye should be routinely re-examined when the surgeon screens the blast injury patient from head to toe prior to anesthesia. The vision evaluation compares sight in the injured eye to the uninjured eye. Severe vision loss in the nonruptured eye is a strong indicator of serious injury.

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