Ocular First Aid Kathryn Lee Clinical Nurse Specialist/Nurse Educator Ophthalmology Department

10 deadly sins of ocular first aid „ „ „ „ „ „ „ „ „

Delaying irrigation Rubbing the eye Continuing CL wear Pressure on globe Delaying timely assessment where appropriate Ongoing use of topical anaesthesia Using solvents/alcohol to clean eye Not assessing VA Not using appropriate eye protection

Basic principles of ocular first aid „ „ „ „ „ „

Protect the eye Prevent further injury Preserve vision Obtain detailed, accurate history Clarify mechanism of injury Prevention is better than cure

Protect, Prevent, Preserve „ „ „ „ „ „ „ „

Immediate irrigation for chemical injury Remove CL Eye pad Clear shield Patient to rest with head elevated Cool compress for minor trauma DO NOT apply pressure to the globe DO NOT remove foreign objects- nails/screws…

Removing CL „ „

Remove only if further injury will not occur May require upper lid eversion „

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Rule out PEI first

Apply fluroscein „

Will stain CL

Eye pad „

Benefit debateable in minor trauma „

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Ensure eye remains closed under pad „

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Advise patient to remove if causes discomfort

Corneal abrasion could result

Secure with tape ???jelonet

Clear shield „

Avoid pressure on globe in PEI „

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Expulsion of ocular contents

Secure with tape Alternative- paper/polystyrene cup Provides protection & reminder to patient $1.50 Health support services „

Expiry date?

Clear shield

Rest with head elevated „ „ „

Reduces swelling Prevents further bleeding Allows hyphaema to settle „ „

Improved VA assessment & ocular exam Reduced endothelial staining

Avoid pressure on globe „

DO NOT put pressure on the globe „

Pressure may cause expulsion of intraocular structures

Foreign bodies „ „

Dirt/eyelash/CL/makeup Avoid rubbing eye „

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May cause corneal abrasion, embedded FB

Remove CL and avoid CL wear Evert upper eyelid- ?subtarsal FB Gentle irrigation provided PEI not suspected

BE AWARE „

High velocity injuries „ „ „

Lawn mowing Metal vs metal with force- hammering metal Use of power tools „ „

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Grinding/drilling metal Nail guns

Potential for intraocular FB

Corneal/conjunctival abrasion „ „ „ „ „

Finger nails/CL/REEs Patch vs no patch Most heal quickly- 1-2/7 Antibiotic cover & lubricants Topical anaesthesia „ „ „

Aid diagnosis of superficial injury Provide pain relief DO NOT use as treatment „

Delayed epithelial healing

Corneal laceration „ „ „ „ „

Sticks/branches/fencing wire/ Partial or full thickness Light dressing- avoid pressure on globe Refer for assessment Rest with head elevated

Lid laceration „

Light pressure „ „ „ „

Do not use cotton wool- fibres DO NOT apply pressure to globe Assess for lacrimal/lid margin involvement Snorkel mask area- refer to ophthlmology

Blunt trauma „

Rest with head elevated „ „ „ „

Prevents further bleeding Reduces swelling Allows hyphaema to settle Patient should be referred for assessment

Ocular injuries in children „ „ „ „

Prevent child rubbing eye as much as possible Swaddle child prn Only attempt FB removal by flushing Chemical injuries „ „ „

Hold lids open If possible have 2nd person to assist Hold child over basin

Ocular burns „ „ „

Thermal Radiation Chemical

Radiation & Thermal burns „

UV „ „ „ „

Sun reflection from water/snow Tanning bed/sunlamp without goggles Welding without eye protection Symptoms usually begin approx 6-12 hours after exposure „

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Thermal burns „ „

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FB sensation, photophobia, tearing

Exposure to heat/cigarettes/curling tongs Less common

Treatment dependant on mechanism & extent

Chemical injury „ „ „ „ „ „

Minor/common Major/less common IMMEDIATE irrigation sight saving Don’t delay irrigation searching for correct solution Tap water suitable first aid Only ocular injury where treatment started prior to testing VA or taking history

Irrigation equipment

Irrigation equipment „

Normal saline „ „ „ „

Preferred solution Studies of appropriate irrigation solutions BSS + most comfortable Limited by need for reconstitution & discard after 6hours

Irrigation equipment

Irrigation equipment „

Giving set „ „

Provides gentle directable flow Able to quickly stem flow

Irrigation equipment

Irrigation equipment „

Receptacle „ „

Kidney dish or similar Should conform to face to prevent spillage

Irrigation equipment „

Topical anaesthesia „ „ „

Benoxinate, Amethocaine Provides comfort Prevents blepharospasm

Irrigation equipment „ „

Gauze &/or tissues Cotton buds „ „

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Aid evertion of upper lid Remove particulate matter

Towels/plastic mac „

Prevent patient becoming saturated

A note about fancy gadgets „ „ „ „

Morgan lens Marketed to aid irrigation We do not use or support use of this product Feedback from patients unfavourable „ „ „ „

Severe discomfort Left unsupervised Obstruction of particles Recommended use with Lactated Ringers

pH testing strips „ „ „

Recommended in literature Difficult to find suitable agent in NZ Pre-irrigation „ „

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Confirms acid vs alkali Confirms chemical exposure

Post-irrigation „

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5-10 minute delay required to ensure testing of tear film Raises concerns if treatment delayed

Positioning patient „ „ „ „ „ „

Ensure patient comfortable Remove CL unless doing so would cause further injury Support head as much as possible Instill topical anaesthetic Position receptacle Tilt head toward side being irrigated „ „ „

Aids flow of irrigation solution into receptacle Prevents contamination of fellow eye Reduces flow of irrigation into lacrymal system

Irrigation procedure „ „

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Positioning patient limited by available equipment Ensure patient moves eye as much as possible while irrigating Irrigate fornices

BEWARE combo deals „

Fireworks „ „ „ „

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Blunt trauma Thermal burns Foreign bodies Chemical exposure

Car airbags „ „ „

Blunt trauma Foreign bodies Chemical exposure

Basic principles of ocular first aid „ „ „ „ „ „

Protect the eye Prevent further injury Preserve vision Obtain detailed, accurate history Clarify mechanism of injury Prevention is better than cure

Questions?