A penetrating eye injury, where an object has broken the surface of the eyeball or entered the eye socket, constitutes a severe medical emergency. This trauma carries a high risk of permanent vision loss due to the delicate structure of the eye. Immediate first aid is important for preserving vision before professional medical intervention. The primary goal of initial care is to protect the eye from further movement or damage.
Immediate Priorities: Securing Help and Safety
The first action upon recognizing a penetrating eye injury must be to activate the emergency medical system by calling 911 or the local equivalent immediately. While awaiting professional help, instruct the injured person to remain as still as possible. Eye movement, even slight, can worsen the injury by causing the penetrating object to shift or tear internal structures.
Have the victim lie flat on their back, ideally with the head and shoulders slightly elevated to reduce pressure within the eye. This position helps keep the patient calm and limits sudden movements that could complicate the injury. If the person is wearing contact lenses or glasses, do not attempt to remove them unless they are already loose. Preventing any manipulation of the area around the eye is the priority.
Critical Actions to Avoid
In the context of a penetrating injury, the instinct to “fix” the problem must be suppressed, as several actions will cause secondary damage. Never attempt to remove the impaled object, regardless of its size. The object may be acting as a plug to control hemorrhage or prevent the loss of internal eye contents, and removal can cause irreparable damage.
It is prohibited to wash, flush, or rub the injured eye under any circumstances. Since the integrity of the globe is compromised, flushing could introduce contaminants or force internal material out. Do not apply any pressure, ointments, or eye drops, as pressure can cause the extrusion of the eye’s contents, and medications may interfere with subsequent surgical procedures.
Stabilizing the Object and Covering the Eyes
Immediate physical care centers on stabilizing the impaled object to prevent movement and secondary trauma during transport. The object must be secured in place without applying pressure to the eye or the object itself. Stabilization requires a protective shield, which can be improvised from a clean, rigid material, such as a paper cup or a small, cone-shaped container.
The protective cover must be placed over the injured eye, completely surrounding the impaled object without touching it. The cup or shield must be large enough so the object remains suspended within the hollow space. Once positioned, the shield should be secured loosely with tape or a bandage that wraps around the head, ensuring the tape does not press down on the eye socket.
Crucially, the uninjured eye must also be covered with a separate, soft patch or gauze. The eyes move in tandem, a phenomenon known as sympathetic movement or conjugate gaze. If the uninjured eye attempts to track movement, the injured eye will move with it, potentially dislodging the penetrating object. Covering both eyes prevents this involuntary movement, minimizing further damage to the injured globe.
Monitoring and Preparing for Medical Intervention
Once the object is stabilized and both eyes are covered, the focus shifts to monitoring the victim while awaiting professional medical assistance. Continuously observe the person’s responsiveness, breathing, and general state to detect signs of shock or deterioration. Keep the victim warm and reassure them calmly, as psychological stress can increase muscle tension and involuntary movements.
Instruct the injured person not to eat or drink anything, as emergency surgery will likely be required upon arrival at the hospital. This “nil per os” (NPO) status is a standard pre-operative precaution. If the patient reports nausea, manage this carefully, as vomiting significantly increases pressure in the head and eye. Gather any information about the object that caused the injury, such as its material or size, to provide details to the arriving medical team.