A sharp object impaled in the eye is a severe and time-sensitive medical emergency that can lead to catastrophic vision loss. The primary goal of first aid is to prevent any further movement or damage to the delicate internal structures of the eye. While the injury is alarming, a calm and immediate response focused on stabilization and professional activation offers the best chance for vision preservation. First aid measures are designed to maintain the current state of the injury until specialized medical care can be reached.
Immediate Steps: Prioritizing Emergency Services
The first action must be to call 911 or your local emergency number without delay. Professional medical help, specifically an ambulance, is required because the victim needs specialized transport to a facility equipped for ocular surgery. While waiting for emergency services to arrive, ensure the victim is lying flat on their back to minimize movement and head elevation.
The injured person will likely be distressed and in significant pain, so keeping them calm is a high priority. Instruct the victim to remain as still as possible and to avoid moving their eyes. Before approaching, quickly assess the immediate environment for any ongoing hazards that could cause further injury to yourself or the patient.
Critical Actions to Avoid
The most important rule in managing an impaled eye injury is to never attempt to remove the sharp object, regardless of how small or superficial it may appear. The object acts like a plug, and its removal could trigger a sudden, severe hemorrhage or cause the internal contents of the eyeball to prolapse, resulting in irreversible damage. Only a qualified surgeon in a sterile environment should remove the object.
A rescuer must also avoid applying any pressure directly to the eye or the impaled object, as this can force the object deeper or cause the fragile contents of the globe to be expelled. Do not allow the victim to rub the injured eye, and do not attempt to flush the eye with water or any other liquid. Furthermore, do not give the victim anything to eat or drink, as emergency surgery may be required upon arrival at the hospital, and an empty stomach is needed for general anesthesia.
How to Stabilize the Impaled Object
Stabilization is necessary to prevent the object from moving during transit, which would cause additional trauma to the surrounding tissue. The goal is to create a protective shield that rests on the bony structures of the face, such as the cheekbone and brow, without touching the object or the eyeball. This shield absorbs accidental bumps or movements.
A common improvised method involves using a clean, rigid protective device, such as a paper cup or the bottom of a Styrofoam cup, if the object is long enough. The cup is placed over the injured eye, centered around the object, ensuring it passes cleanly through the cup’s opening without contact. If the object is too short for a cup, a “donut” dressing can be fashioned by wrapping gauze or a cravat into a ring shape.
The donut or shield should be secured gently but firmly in place with roller gauze or medical tape wrapped around the head. Ensure the cup’s rim or the donut rests only on the facial bones. The primary function of this bulky dressing is to immobilize the impaled object and prevent accidental pressure from reaching the eye. This stabilization method is the most practical step a first responder can take to minimize further injury.
Preparing for Transport and Medical Care
Once the object is stabilized, prepare the victim for transport and prevent any involuntary movement of the injured eye. Human eyes naturally move in tandem, a phenomenon known as conjugate gaze. When the uninjured eye attempts to look around, the injured eye will also move, which can cause the impaled object to shift and worsen the trauma.
To counteract this, the uninjured eye must also be covered with a simple patch or dressing, ensuring the victim cannot see through either eye. This measure forces both eyes to remain still. It is important to continuously monitor the victim’s breathing and level of consciousness, as an eye injury can sometimes be associated with more serious head trauma.
The rescuer must also gather all relevant information, including the time and nature of the accident, and the type of object involved. This information should be relayed to the emergency medical personnel immediately upon their arrival. Maintaining constant verbal reassurance is helpful, as the temporary loss of sight due to the patches can be terrifying for the victim.