Consultation with the Specialist

Abstract

Optimal management of eye trauma requires a careful history, a controlled examination, protective measures to limit the damage and prevent infection, and swift triage to an ophthalmologist. Personnel in the emergency department or office can accomplish these goals and save the patient permanent visual disability. How Does One Evaluate Trauma to the Eye? A systematic approach emphasizing history, visual acuity, and external examination are essential in the evaluation of eye injuries. The history should be detailed and should note the mechanism of injury, the events following the injury, preexisting eye disorders, systemic disorders, drug allergies, contraindications to anesthesia, when the patient last ate, and prior tetanus immunization. If ocular perforation, laceration, or intraocular foreign body is suspected, treat the patient as if preoperatively, allowing nothing by mouth, and consider intravenous antibiotics to protect against exogenous endophthalmitis. Visual acuity examination must be performed in every case. Measure the visual acuity in each eye separately with corrective lenses in place. A near card may be used for examination at bedside. Picture cards and charts are available for measuring acuity in children age 3 to 6 years. Preverbal children can be tested grossly by allowing them to reach for a small toy with one or the other eye covered.