Transcript Document
Open Globe Injury Guidelines for Evaluation of Suspected Open Globe Injury • • • • Ruck Maintain high suspicion for open globe injury Rigid eye shield to prevent further damage Moxifloxacin 400mg PO/IV (endophthalmitis prophylaxis) Ondansetron • 4-8mg PO • 4mg IV over 2-5 min • 4mg IM • Pain control (ketamine approved) • Activate evac (URGENT) • Goal is surgery within 24 hours Truck • Moxifloxacin 400 mg PO/IV if not given • Position supine with head elevated House Plane Critical Items History: • Blast injury • Metal on metal impact • Blunt trauma to ocular region Concurrent trauma • Lid lacerations • Penetrating periocular trauma Physical Exam: • Visual acuity • Afferent pupillary defect • Suspicious findings • Peaked pupil • Abnormal anterior chamber depth • Hemorrhagic chemosis • Eyelid edema • Traumatic cataract • Definitive findings: • Obvious laceration/rupture • Prolapsed ocular contents • • • • • Detailed evaluation as possible per guidelines Initiate teleconsult with photos Ultrasound contraindicated for suspected open globe injury Tetanus prophylaxis as available (Tdap 0.5ml IM) Continue endophthalmitis prophylaxis • Additional dose of moxifloxacin 400 mg PO/IV at 12 hrs • Continue moxiflxacin 400 mg PO/IV q day x 5 days • Add clindamycin 300mg IV every 8 hours if available* • Maintain patient comfort and supine/head elevated positioning • • • • • Continue above treatments • Rigid eye shield • No altitude restrictions for open globe Abnormal anterior chamber depth Endophthalmitis Infection inside the eye Rsk is increased with delayed wound closure and in injuries in rural settings Increasing pain, decreased vision Red, angry eye, hypopyon, cloudy vitreous Cloudy vitreous behind lens Hypopyon Hemorrhagic chemosis Red, inflamed eye Peaked pupil Occult rupture Endophthalmitis