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Now let's cover the topic of eye injuries, of which there can be a couple of main types. One is an object embedded in the eye. The other is a chemical in the eye. In this case, we're going to be first addressing the object in the eye. In this case we know that the worker was by a grinding wheel, and potentially one of the brushes may have flown off the wheel and embedded in their eye. They're in a great deal of pain. We've gone ahead and assessed for scene safety, our gloves are on, and also the patient is not suffering from airway, breathing, or circulation problems at this time, so they're remaining fairly stable. We guided them to a place where they could be sat down carefully and now treated, and here's what we're going to do. We find a cup. It's important to understand that we want to actually get something that goes over the wounded eye so that we don't put any pressure on the object that's embedded in the eye. The second thing too is, if you have a medical grade cup, that's fine, but you could also use a Dixie cup or a drinking cup, a styrofoam cup, a coffee cup. It really doesn't matter. It doesn't have to be overly large, because that's going to cause some problems in trying to bandage around it, so the smaller, the better. But we do want it to be at least deep enough that it keeps the pressure off from that eye. The second point to make is that we want to bandage both eyes shut because eyes tend to move together. So if we leave one eye unbandaged so the person can see, when they move that eye they will also be moving the affected eye, and we don't want to cause further harm. The third point, and lastly, we can have the patient assist us, when we're having them hold the cup or hold things in place while we bandage. So here we are. I'm just going to go ahead and put this cup over your affected eye, ma'am. Go ahead and take your hand away. Now can you hold that cup in place? Now the second thing I'm going to do-- and be sure to talk to your patient. They're kind of blind at this point, so you want to be really communicating with them, instead of making them guess what they're feeling, like, "Now I'm putting a cup on your eye, and now I'm going to throw a bandage on your eye." Explain what you're going to do before you do it, so we don't shock them. And then the other thing to remember too is, once this is all bandaged, they're blind. We're going to have to lead them as if they are blind, making sure to remind them where to step, how to step, so they don't fall down. And ideally we're going to transport this patient via EMS, because there's things that we can do en route that might not be able to be done in a private car. But if the EMS is not an option, private car may work as long as the patient is stable and doesn't have any other injuries that would stop them from being transported. So I took another 4x4 gauze. If you had an actual eye bandage, you could use that, certainly, but a 4x4 gauze is not a problem either. Ma'am, I'm going to put this over your non-affected eye, and you can hold that in place, and I'm just going to wrap a gauze around both of them. Go ahead and let go of the cup side. I'm going to put a bandage around. Let me know if that hurts at all, okay? Not the eye that's hurt, but I mean, as I'm wrapping, any new pain. Now I'm going to go ahead and wrap around this. You can let go. And I'm just going to continue here. I know that's over your nose, but I'll move that in just a second, okay? I'm going to continue to bandage around, and probably just a good couple times. You just want to make sure that the cup is not going to slip. And then once you come back around to the other side, we tuck the excess in underneath the bandage, as long as it's not putting too much pressure. Or you could always tape it in place. Is that fairly comfortable, ma'am? I'm going to go ahead and lift this over your nose so you can breathe okay. Now the patient is packaged and ready to go. Now we're going to be doing our secondary survey, which is doing a double-check. This is a pretty distracting injury, so it could take our eyes, our eyes as rescuers, off from other things that might be happening. Maybe she fell after she got the injury in the eye and hit her head. So we're always going to be assessing for level of consciousness, airway, breathing, circulation, signs of shock, and treating accordingly, as we get this person into definitive care and back on track. And now let's take a look at the other type of eye injury, which is chemical burns. Whether a dry chemical or a liquid chemical, it can cause a great amount of damage to this eye and the mucous membrane of the eye in a relatively short amount of time. So getting the person to a position where we can actually start to dilute the chemical as soon as possible is essential. Now we would like to use a balanced solution as far as pH goes, but if you only have the tap water out of a sink, or you have bottled water, drinking water, anything is going to be better than nothing. If it's a dry chemical, we're going to brush as much of the excess off as we can before we begin to dilute it and flush the eye. If it's a liquid, we're just going to begin flushing. A key point here: If it's one affected eye, we want to go from the inside of the eye and rinse to the outside. We don't want to cross-contaminate eyeballs. We don't want to flush from outside in, as it can then run over the bridge of the nose into the non-affected eye. Now we've got chemical exposure to both eyes. Remember that we're going to flush for no less than 20 minutes to dilute and to bring the solution into a position where it's not causing damage. We're going to transport this person to an emergency room as soon as possible, and we're going to watch for other life-threatening issues. Remember, the chemical that went in the eye could have also gotten into the mouth, nose, or airway, so we don't want to take for granted that this is an isolated injury. So we're going to continue to assess our patient from head to toe, looking for life-threatening situations like airway, breathing, circulation, or shock symptoms, and treat accordingly, and then continue to flush those eyeballs out so that we can get the chemical out and stop the burning from happening.
Injuries to the eye can involve the eyeball, the bone, and the soft tissue surrounding the eye. Blunt objects, like a fist or a baseball, can injure the eye and/or the surrounding area. Or a smaller object could penetrate the eyeball. Care for open and closed wounds around the eye as you would for any other soft tissue injury.
In this lesson, when we talk about treating an eye injury, assume we're referring to treating an injury from an object. Near the end we'll present some information on the other type of eye injury – chemical injuries.
How to Assess and Treat Eye Injuries
As always, the first thing you want to do is make sure the scene is safe and that your gloves are on. Make sure you have your rescue mask with a one-way valve handy and introduce yourself to the victim.
"Hi, my name's _____. I'm a paramedic. I'm going to help you."
Once you've ensured that the patient isn't suffering with airway, breathing, or circulation issues, the first thing you want to do is assess what type of eye injury you're dealing with – object or chemical? Both are serious!
Pro Tip #1: Eye injuries are serious and always warrant a trip to the ER, whether by calling 911 and activating EMS or by private vehicle. Therefore, the job of the responder is to stabilize the wound, stop the damage, and ready the patient for safe transport.
Sequence of Treatment for Eye Injuries
- Sit the patient down and facing you if possible.
- Place a small cup over the injured eye to eliminate any more damage or pressure. Ask the victim to hold the cup in place.
Pro Tip #2: If you don't have a medical grade cup, a Dixie cup is a suitable alternative. And smaller is better as you'll have tape over it.
- Ask the patient to close their other eye and cover it with any eye bandage or a standard 4”x4” gauze pad.
Warning: Why bandage a good eye? Eyes tend to move directionally together. Leaving one eye free to roam means the other eye – the injured eye –will move as well. While also covering the good eye means neither will move.
- Using a gauze bandage, begin wrapping over the cup and injured eye first, while asking the patient to let go of the cup. Continue wrapping around the back of the head.
- Wrap over the gauze pad and uninjured eye, while asking the patient to let go of the pad and continue wrapping – cover the victim's head two to three times. Tuck or tape the end of the gauze to hold it in place.
Pro Tip #3: Your patient is essentially blind now. So, be extra communicative and always talk to them as you're helping them. Let them know what you're doing and why you're doing it. And keep in mind that they'll continue to need help – getting to their feet, into and out of a private vehicle or EMS vehicle, etc.
- Make sure the victim's nostrils are free and clear of the bandage and ready the patient for transport.
- Perform a secondary survey as you do the above. Assess the patient for secondary issues, from head to toe. And as always, continue to assess for signs of something more serious. How are the pupils? Is the patient breathing normally? Is the patient still responsive and seemingly alert? And continue to monitor the patient for signs of shock.
A Word About Chemical Eye Injuries
This section will mirror the last lesson on the importance of, and strategies for, diluting chemical burns. Only with the eyes, and particularly the mucous membrane, damage can occur very quickly. Meaning your quick actions are essential.
There are two types of chemical eye injuries – dry or wet. If you're dealing with dry chemicals, brush as much off the eye as you can before beginning to flush with a solution. If you're dealing with a wet chemical, go right into flushing the eye.
Pro Tip #4: Ideally, you'll have a balanced pH solution for moments like this. Otherwise, use what you have access to – tap water, bottled water, etc. Flush the injured eye for at least 20 minutes. Your goal here is to stop the damage from the chemical.
Warning: Always rinse from the inside of the eye to the outside of the eye. Flushing the eye the other way – from the outside in – could lead to cross-contamination of the other eye.
While readying the patient for transport, and during your secondary survey, make sure the victim didn't get any chemicals into their mouth, nose, ears, etc. if they did, treat accordingly.