Ocular Emergencies: Critical First Aid Before You Reach the Ophthalmologist
In ophthalmology, the phrase "time is tissue" is often used to describe the urgency of ocular emergencies. The actions taken in the first few minutes after an injury often determine the long-term prognosis for vision preservation.
At Constantia Eye Clinic, we strongly advise patients to seek professional care immediately following an eye injury. However, the first aid administered before arrival at the clinic is equally vital. This guide outlines the clinical protocols for managing common ocular emergencies at the scene.
1. Chemical Exposures: Irrigate Immediately
Chemical burns constitute a true ocular emergency. Whether acidic (e.g., battery acid) or alkali (e.g., drain cleaners, cement, plaster), chemical agents can penetrate the ocular surface rapidly, causing irreversible damage to the cornea and internal structures. Alkali burns are particularly dangerous as they continue to penetrate deeper into the eye even after initial contact.
Immediate Action Protocol:
Do not wait: Do not waste time looking for specific antidotes or sterile saline.
Irrigate instantly: Use the nearest source of clean water (tap water, shower, bottled water) to flush the eye.
Technique: Hold the eyelids open manually to ensure water reaches underneath the upper and lower lids where particulate matter can get trapped.
Duration: Continue flushing for at least 15 to 20 minutes non-stop while en route to emergency care.
2. Penetrating Injuries and Foreign Bodies
This category includes situations where an object (metal shard, glass, pencil, etc.) has pierced the eye or is embedded in the surface.
Critical Contraindications (What NOT to Do):
NEVER attempt to remove the object: Pulling out a penetrating object can cause prolapse of intraocular contents (iris or vitreous), worsening the injury significantly.
DO NOT rub the eye: This may drive a surface foreign body deeper into the cornea.
DO NOT apply pressure: Pressure on the globe can force internal fluid out of the eye.
Stabilization Protocol:
Shield the eye: Place a rigid shield over the eye to prevent accidental pressure. If a medical shield is unavailable, the bottom of a paper cup can be cut out and taped over the orbital rim.
Seek immediate care: Contact your ophthalmologist or visit your nearest emergency department.
3. Blunt Force Trauma
Impact from a fist, ball or steering wheel can cause injuries ranging from a simple subconjunctival hemorrhage to a "blowout" fracture of the orbital floor or a hyphema (bleeding inside the front chamber of the eye).
Immediate Action Protocol:
Cold Compress: Apply a cold compress gently to the skin around the eye to reduce swelling. Do not apply pressure directly to the eyeball itself.
Inspect pupil shape: If the pupil appears teardrop-shaped or irregular, it may indicate a ruptured globe. Treat this as a penetrating injury (see above).
Keep head elevated: This helps reduce swelling and allows blood to settle if a hyphema is present.
4. Sudden, Painless Vision Loss
Not all emergencies involve trauma. A sudden loss of vision—like a curtain coming down—without pain can indicate a Retinal Detachment or a Retinal Artery Occlusion (eye stroke).
Symptoms: Flashes of light, a swarm of new floaters or a dark shadow in the peripheral vision.
Action: This requires immediate specialist intervention to prevent permanent blindness. Proceed to an ophthalmologist without delay.
A Note on Triage
While this guide provides pre-clinical advice, it is not a substitute for professional treatment. If you are unsure about the severity of an injury, always err on the side of caution.
For emergency consultations: Please contact Constantia Eye Clinic immediately. If the injury occurs outside of practice hours you may contact our ophthalmologist on our emergency number 0836009475. You can also proceed to the nearest hospital emergency department with an on-call ophthalmologist.
