First Aid in Ocular Injury: Trauma, Foreign Body or Chemical Injuries

• Symptoms: Severe pain, decreased vision, visible foreign body.
• First Aid: Do not remove the foreign object.
• Shield the eye without putting pressure.
• Keep the patient calm and upright.
• Immediate emergency referral to an ophthalmologist.

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B. Chemical Injuries (Ophthalmic Emergency)

1. Alkali Burns (e.g., ammonia, lime) – more dangerous
2. Acid Burns (e.g., sulfuric acid, hydrochloric acid)
   • Symptoms: Redness, pain, photophobia, corneal haze.
   • First Aid:
     • Immediate and copious irrigation with sterile saline or clean water for at least 15–30 minutes.
     • Ensure eyelids are fully opened during irrigation.
     • Do not delay irrigation for any reason.
     • After irrigation, urgent ophthalmological referral.

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C. Foreign Body on Ocular Surface

• Symptoms: Gritty sensation, redness, excessive tearing.
• First Aid:
  • Instruct the patient not to rub the eye.
  • Attempt gentle irrigation with sterile saline.
  • Do not attempt removal if the foreign body is embedded.
  • If unsuccessful, refer to an ophthalmologist.

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D. Corneal Abrasion

• Symptoms: Pain, tearing, photophobia, foreign body sensation.
• First Aid:
  • Do not patch the eye (unless directed by an ophthalmologist).
  • Topical antibiotic drops/ointment to prevent infection.
  • Refer for fluorescein staining and ophthalmic examination.

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E. Radiation Injury (e.g., Snow Blindness, Welder’s Flash)

• Symptoms: Redness, pain, blurred vision after UV exposure.
• First Aid:
  • Cool compresses for comfort.
  • Analgesics for pain relief.
  • Eye patching is generally not recommended.
  • Referral if pain and symptoms persist.

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F. Heat Oil Drop in the Eye

(e.g., hot cooking oil splashes causing thermal injury)

⚠️ Symptoms:

• Pain, redness, swelling
• Tearing, photophobia
• Possible burn to eyelid or ocular surface

🏥 First Aid Steps:

1. Immediate Irrigation:
   • Rinse the eye with sterile saline or clean, cool water for at least 15–30 minutes.
   • Ensure the eyelids are fully open during rinsing.
2. Pain Management:
   • Use a cool compress over closed eyelids (do not apply ice directly).
3. Avoid:
   • Do not apply ointments or any medication without medical advice.
   • Do not rub the eye.
4. Urgent Referral:
   • Ophthalmology consultation is mandatory to assess for corneal burns, symblepharon, or intraocular injury.

⚡ Red Flag:

• If vision is reduced or there is blistering, urgent specialist review is essential.

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G. Fevikwik (Cyanoacrylate/Super Glue) Drop in the Eye

(Accidental glue exposure to ocular surface)

⚠️ Symptoms:

• Eyelid stuck together
• Foreign body sensation
• Possible conjunctival or corneal abrasion

🏥 First Aid Steps:

1. Do Not Force Eyelids Open:
   • Do not pull apart glued eyelids; this may cause eyelid lacerations.
2. Immediate Irrigation:
   • Flush the eye with saline or clean water for at least 15–30 minutes.
   • This helps to remove unbonded glue and minimize chemical irritation.
3. Do Not Use Solvents:
   • No acetone or chemicals should be applied near the eye.
4. Warm Compresses:
   • Apply a warm compress to loosen the glue naturally.
5. Ophthalmology Referral:
   • A trained professional can gently separate the eyelids and assess for corneal injury.
6. Aftercare:
   • Topical antibiotics may be prescribed if there is a risk of corneal abrasion.

⚡ Red Flag:

• Immediate referral if there is vision loss, eye pain, or inability to open the eye after irrigation.

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H. Bee Sting in the Eye

(Ocular injury from bee venom and possible stinger retention)

⚠️ Symptoms:

• Pain, redness, swelling of eyelids
• Tearing, photophobia
• Blurred vision (if corneal involvement)
• Allergic reactions (systemic)

🏥 First Aid Steps:

1. Remove the Stinger Promptly:
   • If visible and not embedded in the eyeball, gently scrape it out using the edge of a clean card (do not squeeze).
   • If the stinger is in the globe, do not attempt removal—urgent ophthalmology referral required.
2. Cold Compress:
   • Apply to reduce swelling and pain.
3. Monitor for Allergic Reactions:
   • Watch for anaphylaxis: difficulty breathing, hives, facial swelling.
   • If present, administer intramuscular adrenaline (0.3–0.5 mg for adults) and call emergency services immediately.
4. Topical and Systemic Medication: (Administered under medical supervision)
   • Antihistamines for allergic response.
   • Topical steroids if corneal inflammation is present.
   • Analgesics for pain relief.
5. Urgent Ophthalmological Referral:
   • Essential to evaluate for uveitis, optic nerve damage, or endophthalmitis.

⚡ Red Flag:

• Sudden vision loss
• Signs of orbital cellulitis (proptosis, eye movement pain)
• Systemic allergic reaction (requires emergency care)

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3. First Aid for Specific Ocular Emergencies

A. Hyphema (Blood in the Anterior Chamber)

• First Aid:
  • Elevate the head of the bed (30–45°) to allow blood settling.
  • Shield the eye (no pressure bandages).
  • Urgent ophthalmological evaluation to prevent glaucoma and vision loss.

B. Orbital Fractures

• Symptoms: Diplopia, enophthalmos, restricted eye movements.
• First Aid:
  • Avoid nose blowing to prevent orbital emphysema.
  • Apply cold compresses to reduce swelling.
  • Immediate referral for imaging (CT scan).

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4. First Aid in Thermal Eye Burns

• Remove heat source immediately.
• Cool the burn with cold, sterile water.
• Do not apply ointments or medications without medical advice.
• Urgent ophthalmology consultation.

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5. Key Do's and Don'ts

✅ Do's:

• Use eye shields, not eye pads, for protection.
• Provide analgesia if needed.
• Maintain head elevation to reduce intraocular pressure.
• Monitor visual acuity regularly.

❌ Don'ts:

• Don’t apply pressure to a suspected globe rupture.
• Don’t use topical anesthetics repeatedly.
• Don’t remove penetrating objects from the eye.
• Don’t delay irrigation in chemical burns.

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6. Red Flags Requiring Urgent Ophthalmic Referral

• Sudden loss of vision.
• Severe ocular pain.
• Suspected globe rupture.
• Large hyphema.
• Chemical injuries not resolving after irrigation.
• Signs of orbital cellulitis (proptosis, ophthalmoplegia, fever).

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7. Mnemonics for Quick Recall

• CHEMICAL Burn First Aid: "IRRIGATE"

  • Immediately
  • Rinse
  • Repeatedly
  • In open lids
  • Generously with saline
  • Assess pH
  • Timely referral
  • Emergency care

• Penetrating Eye Injury: "SHIELD"

  • Shield the eye
  • Handle gently
  • Immobilize
  • Ensure no pressure
  • Limit movement
  • Direct urgent referral

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8. Conclusion

Prompt, appropriate first aid in ocular injuries can prevent permanent vision loss and reduce complications. As an medical student, it is crucial to recognize eye emergencies and ensure timely ophthalmological referral after initial stabilization.