A penetrating eye injury is a severe ophthalmic trauma where an object has broken through the outer layers of the eye, such as the cornea or sclera, and remains embedded. This injury constitutes a medical emergency that poses an immediate threat to vision and the structural integrity of the eyeball. The primary objective of first aid is to prevent any movement or pressure that could worsen the internal damage, often referred to as an open globe injury, while awaiting professional medical assistance. Stabilization of the object and the patient is crucial to preserve vision and tissue until emergency medical services (EMS) arrive and transport the individual to a specialized facility.
Critical Actions to Avoid
The most immediate danger in managing a penetrating eye injury is the instinct to remove the impaled object, which must be strictly avoided. Removing the object can trigger a sudden, catastrophic hemorrhage or lead to the expulsion of delicate intraocular contents, causing irreversible vision loss. The object may be temporarily plugging the wound, and its removal could cause significant loss of the eye’s fluid or tissue.
It is equally important to never rub, rinse, or flush the injured eye with water or any solution. Rubbing can cause the impaled object to move, leading to further laceration and tissue damage. Rinsing or flushing is only appropriate for chemical burns or superficial foreign bodies. In this case, fluid pressure could force the object deeper or wash out the eye’s internal structures through the penetration site.
Any form of pressure applied to the eye or the surrounding area can be extremely damaging. Pressure can cause the contents of the eye to be squeezed out of the open wound, a phenomenon known as extrusion of globe contents. When applying bandages or dressings, ensure they rest only on the bony socket (orbital rim) and avoid the eyeball itself.
The injured person should not be given anything by mouth, including food, water, or oral pain medication. Penetrating eye injuries almost always require emergency surgery to repair the damage. Maintaining a status of “nil per os” (NPO) ensures the patient has an empty stomach, which is necessary for general anesthesia and reduces the risk of aspiration during surgery.
Securing the Impaled Object
The single most important hands-on procedure is to immobilize the impaled object to prevent it from moving or causing additional tearing of the ocular tissue. Stabilization is achieved by creating a rigid protective barrier, or shield, that covers the eye without putting any pressure on the globe or the object itself. This protective cover must not be a soft dressing or eye patch, which could press down on the injury.
A commercially available rigid eye shield is ideal, but in a first aid scenario, you can improvise a suitable shield using materials like a paper cup or the bottom of a milk carton. The shield must be large enough to completely cover the eye and the protruding object without making contact with either. If using a cup, cut a notch out of the rim to accommodate the contours of the patient’s nose and brow bone, ensuring a stable fit.
Once the shield is positioned, secure it gently but firmly in place using tape or a roller bandage wrapped around the head. The shield’s edges must rest only on the bony prominence of the orbital rim, distributing pressure away from the delicate eye structure. Bulky dressings or gauze can be placed around the base of the object to further minimize movement before the shield is applied, taking care not to push the object inward.
This protective measure is often referred to as “shield and ship” in prehospital care protocols, emphasizing the urgency of transport after stabilization. The goal is to ensure the impaled object remains stationary until a surgeon can safely address the injury.
Preparing for Medical Transport
After stabilizing the impaled object, prepare the individual for transport and manage their overall condition. The person should be positioned lying flat on their back to minimize movement of the head and eye. If the person is conscious and comfortable, slightly elevating the head to about 15 to 30 degrees can help reduce intraocular pressure, but this should not delay transport.
A crucial step is to cover the uninjured eye as well, typically with a soft patch or gauze. The eyes are neurologically linked and move together in tandem, a phenomenon called sympathetic eye movement. When the uninjured eye attempts to look around, the injured eye moves simultaneously, causing the impaled object to shift and potentially inflict more damage. Covering both eyes effectively restricts all eye movement, providing the best chance for tissue preservation.
The injured person will likely be anxious, so maintaining a calm, reassuring demeanor is important for minimizing distress. Anxiety and pain can increase blood pressure and intraocular pressure, which is detrimental to the injury. Monitor for signs of shock, and keep the person still and warm with a blanket until EMS takes over.