An Evidence-Based Approach To Traumatic Ocular Emergencies

Alteveer, Janet MD, FACEP
Lahmann, Brian MD, MHA
Sharma, Adhi MD, FACMT, FACEP
Walther, Timothy MD

Janet Alteveer, MD, FACEP
Associate Professor of Emergency Medicine, Robert Wood Johnson Medical School, Camden, University of Medicine and Dentistry of New Jersey; Faculty and Staff Physician, Emergency Department, Cooper University Hospital, Camden, NJ
Brian Lahmann, MD, MHA
Staff Physician, Department of Emergency Medicine, The Reading Hospital and Medical Center, Reading, PA
Peer Reviewers
Adhi Sharma, MD, FACMT, FACEP
Chairman, Department of Emergency Medicine, Good Samaritan Hospital Medical Center, West Islip, NY
Timothy Walther, MD
Instructor of Emergency Medicine, Elmhurst Hospital Center, Mount Sinai School of Medicine, New York, NY

Emergency Medicine Practice 12(5):p 1-21, May 2010.

A 21-year-old male presents to the ED complaining that his vision seems “wavy,” as if something is jiggling inside his eye. One hour earlier he was standing on the street when he heard what sounded like a gun firing. He felt “something funny” in his eye, but there was no blood and no real pain. On exam there is no periorbital swelling and no obvious trauma to the eye itself. His visual acuity is 20/40 in the right eye and 20/30 in the left. Further examination of the right eye reveals a small gray mark in the sclera just lateral to the iris. You wonder if this could be an entry wound and, if so, what would be the best way to detect an intraocular foreign body (IOFB). You also wonder whether you should administer an antibiotic.

While you are thinking about the young man's problem, another patient with an eye complaint arrives in the ED. A 55-year-old woman presents with pain in her eye after walking along a wooded trail. She thinks that she felt something fly into her left eye, and the pain started after she rubbed her eye. Back at home, she rinsed her eye out with some water and OTC eye drops, with no relief. She reports excruciating, 10/10 pain and tearing; the bright light bothers her, and she claims she cannot tolerate an eye exam. You wonder what you can do to facilitate her evaluation and why her injured eye hurts more when the light hits her uninjured eye.