Pre-Ophthalmologist Management of Eye Trauma

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Article initiated by:
Jonathan (Eugene) Rho
All contributors:
Brian Jerkins, MD, Brian T. Fowler, MD, Stephen C. Dryden, M.D., Anna Murchison, MD, MPH, Grant A. Justin, MD, Michael T Yen, MD, Joseph Giacometti, MD, Grayson W Armstrong MD MPH, Henry Bair, MD, Kara Ye, MD
Assigned editor:
Grayson W Armstrong MD MPH, Joseph Giacometti, MD
Review:
Assigned status Up to Date
 by Joseph Giacometti, MD on September 14, 2026.


Introduction

Eye trauma can threaten vision before an ophthalmologist is available. This article addresses recognition, initial treatment, and referral by emergency medical services (EMS), emergency department, and community clinicians. EMS care must follow local protocols and scope of practice; tonometry, medications, procedures, and imaging require appropriate training and clinical supervision.[1]

After lifesaving stabilization, chemical exposure and clinically evident orbital compartment syndrome may require treatment before a complete eye examination. Begin irrigation immediately for an ordinary chemical splash. A trained clinician should decompress orbital compartment syndrome promptly when rapid assessment does not suggest an open globe. When an open globe is suspected, avoid pressure and manipulation, apply a rigid shield, and obtain immediate ophthalmology assistance. Combined chemical and mechanical injury, or simultaneous orbital compartment syndrome and open globe, requires the specific precautions described below.[1][2][3]

Epidemiology

Eye injuries account for a substantial number of emergency visits, although estimates depend on the population, setting, and definition used. In a historical analysis of the 2008 US Nationwide Emergency Department Sample, AHRQ estimated approximately 640,000 eye-injury-related visits, or 209 per 100,000 population.[4] Most visits did not result in hospital admission, but a smaller group of injuries can cause irreversible visual loss. Initial care should therefore prioritize recognition of time-critical injury, prevention of further ocular damage, and appropriate ophthalmology referral.[4]

Open and closed globe injury classification system.

Injury Classification

Mechanical globe injuries are classified as open or closed under the Birmingham Eye Trauma Terminology system. An open globe has a full-thickness wound of the cornea or sclera; a closed globe has no full-thickness eyewall wound.[5]

  • Rupture is caused by blunt trauma. The eyewall fails from an inside-out mechanism at a weak point that may be remote from the impact.[5]
  • Laceration is an outside-in injury. Penetrating injury has an entrance wound; perforating injury has entrance and exit wounds caused by the same object. An intraocular foreign-body injury retains the causative object within the eye.[5]
  • Closed-globe injuries include contusions and partial-thickness, or lamellar, lacerations.[5]

For open globe injuries, zone I involves the cornea and limbus, zone II involves sclera up to 5 mm posterior to the limbus, and zone III extends farther posteriorly. The most posterior wound extent determines the zone. Document mechanism, wound location, presenting vision, and pupil findings when available, but defer detailed wound characterization if it would require pressure or delay urgent care.[6]

Orbital and eyelid injuries may coexist with globe injury. A fracture does not exclude rupture, retinal injury, traumatic optic neuropathy, or orbital compartment syndrome. Referral urgency should follow the associated ocular findings rather than the fracture label alone.[2][7]

Initial Approach

Address airway, breathing, circulation, major hemorrhage, and associated head or cervical-spine injury first. Do not postpone chemical irrigation or indicated orbital decompression for a lengthy history, detailed examination, imaging, or routine transfer arrangements.[1][2]

  1. Obtain a focused history while arranging treatment. Record the mechanism and time of injury, symptoms and baseline vision, previous ocular surgery, contact lens use, allergies, medications including antithrombotics, tetanus immunization, and last oral intake. High-velocity metal-on-metal injury, an impaled object, blast exposure, or blunt trauma to an eye with a previous surgical wound raises concern for an open globe or intraocular foreign body.[8]
  2. Document visual acuity in each eye separately when possible, using the patient's usual correction or a pinhole if this is safe. If chart testing is impossible, record counting fingers, hand movements, or light perception, including the testing distance when relevant. Assess pupil size, shape, and reactivity before pharmacologic dilation. A relative afferent pupillary defect (RAPD) suggests asymmetric optic nerve or substantial retinal dysfunction, although symmetric bilateral injury may produce no RAPD. These findings inform urgency and prognosis without determining treatment futility.[1][8][9]
  3. Inspect without pressing on the globe or forcing swollen lids apart. Note a visible wound or protruding object, pupil distortion, anterior-chamber asymmetry, hyphema, marked subconjunctival hemorrhage, proptosis, and eyelid injury. Test voluntary eye movements and confrontation fields if the patient can cooperate and this does not delay care. A limited or apparently reassuring examination does not exclude a posterior rupture or retinal injury.[8][10]
  4. Measure intraocular pressure (IOP) only when an open globe has been reasonably excluded and a trained clinician can do so safely without delaying indicated decompression. Compare both eyes when safe. Low IOP may suggest globe disruption, but neither normal nor high IOP excludes an open globe. Avoid tonometry, globe palpation, retropulsion, forced ductions, and ocular ultrasound when rupture is suspected.[2][8]

For suspected globe disruption or another severe ocular injury, use a rigid shield resting on the orbital bones without contacting the globe. Avoid a pressure patch, circumferential wrap, or gauze beneath the shield. Leave embedded or protruding objects in place and protect them from accidental contact. Provide systemic analgesia and antiemetics, and elevate the head when compatible with other injuries and hemodynamic status.[1][8]

Pre-Ophthalmologist Management of Threats to Vision

Chemical Injury

Alkalis can penetrate rapidly, while acids usually cause more superficial protein coagulation. This distinction does not establish severity: concentrated acids, hydrofluoric acid, and agents with an additional thermal effect can also cause deep injury. Concentration, duration of contact, retained particles, and the affected ocular surface influence the damage.[11]

For an ordinary splash, start copious irrigation immediately with clean water, saline, or another suitable available solution. Do not wait for a preferred fluid, identification of the chemical, a full examination, or ophthalmology. Protect staff from contamination and direct fluid away from the unaffected eye. Remove contact lenses when readily possible without interrupting irrigation; do not attempt chemical neutralization with an opposing acid or alkali.[11][12]

If pH paper is immediately available, check the ocular surface pH of both eyes without delaying irrigation. Continue until pH is physiologic, approximately 7.0–7.2. Pause for at least 5 minutes before rechecking so that residual irrigation fluid does not mask retained chemical. Resume irrigation if pH remains abnormal or rebounds, inspect for retained material, and repeat checks after apparent normalization. A stable pH and removal of retained material guide the endpoint rather than a fixed volume or duration.[11][12]

A trained clinician may use an ophthalmic topical anesthetic to facilitate irrigation. After an open globe has been excluded, evert the lids, inspect the fornices, and remove retained particles. An irrigation lens can assist delivery but does not remove particles and should not be inserted when an open globe or embedded object is suspected. Once decontamination is complete, assess vision and the corneal, conjunctival, and limbal injury, measure IOP when safe, and obtain urgent ophthalmology evaluation. Further anti-inflammatory and pressure-lowering treatment should follow ophthalmic assessment.[11][12]

If an open globe is known or strongly suspected, do not irrigate the open globe, apply pressure, insert an irrigation lens, or remove a protruding object. Decontaminate surrounding skin without directing fluid into the wound, place a noncontact rigid shield, and obtain immediate ophthalmology, trauma, and toxicology guidance. A hypothetical concern for rupture after an otherwise ordinary splash should not delay irrigation. See Chemical (Alkali and Acid) Injury of the Conjunctiva and Cornea.[3]

Orbital Fractures

Orbital floor and medial wall fractures commonly follow blunt trauma. Diplopia or restricted eye movement may reflect muscle or soft-tissue entrapment, edema, or nerve injury. Infraorbital nerve injury can cause numbness of the cheek, upper lip, and upper teeth. Medial wall or naso-orbital trauma can also affect the lacrimal drainage system or medial canthal tendon.[13]

First assess for vision-threatening associated injuries, particularly open globe and orbital compartment syndrome. Record visual acuity and pupil findings when safe. After excluding an open globe, assess ocular movements without forcing them and compare globe position. New visual loss, an afferent pupillary defect, proptosis, or rapidly worsening pain requires urgent ophthalmic assessment; clinically evident orbital compartment syndrome requires immediate decompression rather than waiting for fracture imaging.[2][7]

Thin-section noncontrast CT of the orbits or facial bones with multiplanar reconstructions defines the fracture and associated hemorrhage, foreign bodies, or optic-canal involvement. Entrapment is a clinical diagnosis supported by imaging: a nondiagnostic CT does not exclude it, especially in children. Do not delay urgent specialist assessment when marked gaze restriction or an oculocardiac response raises concern.[7][14]

Children may have a trapdoor fracture with little bruising or swelling despite tissue incarceration. Marked restriction, pain with attempted eye movement, nausea or vomiting, bradycardia, or syncope after periocular trauma should prompt concern for entrapment and the oculocardiac reflex. Suspected entrapment requires urgent ophthalmology and orbital-surgical assessment for release; it should not be managed as routine outpatient swelling.[7][14]

Forced-duction testing may help distinguish mechanical restriction, but it manipulates the globe. It should be performed only by an ophthalmologist or appropriately trained orbital clinician after an open globe has been excluded; it is not a routine EMS examination.[7]

Advise the patient not to blow the nose because air can enter the orbit through the fracture. Prior to discharge, patients should be counseled on sinus precautions and instructed to seek prompt evaluation for warning signs such as new or worsening vision loss, increasing periorbital swelling, proptosis, eye pain or pressure, crepitus, diplopia, or restricted extraocular movements. Give analgesia and control nausea. After globe integrity has been established, head elevation and gentle cold compresses may reduce swelling; avoid pressure on the eye. If urgent operative treatment is possible, keep the patient nil per os and coordinate transfer.[7][13]

Routine prophylactic antibiotics are not recommended for closed, nonoperative orbital fractures in the AAST consensus for adult trauma patients aged 16 years or older. Open or contaminated wounds, infection, and operative prophylaxis require separate assessment; sinus communication alone does not establish a need for antibiotics. Medication decisions in younger children should follow pediatric and specialist guidance.[15] Systemic corticosteroids should be reserved for selected specialist-directed indications rather than started empirically for undifferentiated orbital trauma.[13]

Without entrapment or another emergency, specialist review and reassessment after swelling subsides determine whether repair is needed. Persistent functionally important diplopia, enophthalmos or globe displacement, and the pattern of tissue herniation contribute to that decision. Fracture size, including involvement of more than half the floor, is one factor rather than an automatic indication for surgery. Arrange follow-up and instruct the patient to return immediately for worsening vision, pain, proptosis, or vomiting.[7]

Orbital Compartment Syndrome

Orbital compartment syndrome (OCS) occurs when rapidly increasing orbital pressure compromises retinal or optic nerve perfusion. Traumatic retrobulbar hemorrhage is a common cause; air, edema, or infection can also increase orbital pressure. Diagnosis is clinical. Concerning findings include acute visual dysfunction, an RAPD, proptosis, tight lids, restricted eye movements, and elevated IOP when measurement is safe. Orbital hemorrhage on CT alone does not establish OCS.[2][16]

Perform a rapid noncontact assessment for an open globe. When globe integrity permits, assess vision, pupils, motility, orbital tension, and IOP, comparing the fellow eye when safe. An IOP above approximately 40 mmHg with compatible findings strongly supports urgent decompression, but a single pressure threshold should not replace clinical judgment. Do not wait for severe visual loss, CT, specialist arrival, or transfer when OCS is clinically evident. There is no reliable universal safe waiting period, and delayed presentation does not establish that decompression is futile.[2][16]

A trained and credentialed clinician should perform immediate lateral canthotomy with complete inferior cantholysis. Canthotomy alone often provides inadequate decompression. Consult ophthalmology concurrently, then reassess vision, pupils, and orbital tension promptly and serially, including IOP when globe integrity permits. Persistent pressure or visual compromise requires urgent specialist assessment for further release or orbital decompression. Medical pressure-lowering treatment is an adjunct and must not postpone the procedure; acute visual benefit from corticosteroids or osmotic agents is not established.[2][16]

An open globe and OCS can coexist. Suspected rupture is a relative contraindication to canthotomy and cantholysis because decompression can worsen ocular injury. Avoid globe palpation and tonometry and obtain immediate ophthalmic and trauma input for an urgent case-specific decision. If specialist assistance cannot arrive promptly, the most experienced available clinician must balance ongoing orbital ischemia against the risk of worsening the globe injury. Imaging and routine transfer logistics must not create avoidable delay. See Orbital Compartment Syndrome.[2]

Open Globe Injury

An open globe is a full-thickness corneal or scleral wound. Blunt trauma causes rupture, whereas a sharp object or projectile can cause a penetrating or perforating laceration or leave an intraocular foreign body. All require emergency ophthalmic assessment. Warning signs include a visible wound or prolapsed tissue, a peaked or irregular pupil, abnormal anterior-chamber depth, markedly reduced vision, or dense circumferential subconjunctival hemorrhage. A subtle wound or posterior rupture may lack obvious external signs.[5][8]

Stop examinations that require pressure or manipulation. Do not perform tonometry or preoperative ocular ultrasound, force the lids open, remove an impaled object, or explore, irrigate, debride, or close the wound. Do not provoke a Seidel test when an open globe is already apparent. Place a rigid shield without underlying gauze and arrange immediate ophthalmology consultation and transfer to a facility with ophthalmic surgical capability.[1][8]

Keep the patient nil per os, establish intravenous access, record last oral intake, and treat pain and nausea promptly. Minimize retching, coughing, straining, and agitation. Elevate the head approximately 30 degrees if systemic injuries and circulation permit. Sedation, when required, should follow the clinician's trauma and monitoring protocols. Begin systemic broad-spectrum antimicrobial prophylaxis promptly according to the local open-globe protocol and ophthalmologist guidance, accounting for age, allergies, renal function, contamination, and foreign-body risk. Medication delivery should not delay transfer or repair.[8][17]

Assess tetanus vaccination and immune globulin according to wound type and immunization history. Penetrating, puncture, crush, devitalized, or contaminated wounds are dirty or major wounds under CDC guidance. An unknown or incomplete primary series warrants vaccination; a completed series requires a booster for a dirty or major wound when at least 5 years have elapsed. Tetanus immune globulin is indicated for dirty or major wounds with an unknown, absent, or incomplete series, or with HIV or severe immunodeficiency. Antibiotics do not substitute for tetanus prophylaxis.[18]

Thin-section noncontrast orbital CT can identify associated injury and assist operative planning, particularly when examination is limited or a foreign body is possible. A negative CT does not exclude an open globe or intraocular foreign body. Avoid MRI while a potentially ferromagnetic intraocular or orbital object remains possible. Imaging must not delay consultation or treatment of a clinically apparent injury.[8][19]

Primary closure should occur as soon as clinically feasible, generally within 24 hours of injury. Evidence associating earlier repair with less endophthalmitis is retrospective and predominantly concerns penetrating and foreign-body injuries; 24 hours is not a safe waiting period for an individual patient. Definitive repair, intraocular antibiotics, and subsequent surgery are ophthalmologist-directed. See Ruptured Globe for blunt injury and the shared initial precautions for suspected open globe.[20]

Traumatic Hyphema

Hyphema

Hyphema is blood in the anterior chamber after injury to iris or ciliary body vessels. A small hyphema, including cells visible only on slit-lamp examination (microhyphema), can still cause pressure elevation. Rebleeding, corneal blood staining, and optic nerve damage are important complications. Assess visual acuity and pupils, examine the anterior chamber, and measure IOP only after an open globe has been excluded. Arrange same-day ophthalmology evaluation, including for microhyphema.[21][22]

While arranging care, place a rigid shield without pressure, elevate the head when medically appropriate, limit strenuous activity, and control pain, nausea, and vomiting. Prefer an analgesic such as acetaminophen when suitable; avoid using aspirin or nonsteroidal anti-inflammatory drugs for analgesia. A medically necessary antiplatelet or anticoagulant should not be stopped automatically: discuss the bleeding risk and the indication with ophthalmology and the prescribing team.[21]

Ask about known sickle cell disease or trait and relevant personal or family history. Discuss testing with ophthalmology when status is unknown and the history, ancestry, or clinical course raises concern; do not use racial identity alone as a diagnostic test. Sickle cell disease or trait can increase the risk of pressure-related injury and changes the threshold for intervention and selection of pressure-lowering medication.[21][22]

Topical cycloplegics may relieve pain and photophobia, and topical corticosteroids may be prescribed for associated anterior segment inflammation. These treatments should follow ophthalmic assessment. Corticosteroids are not pressure-lowering drugs and can elevate IOP. The 2023 Cochrane review found no demonstrated improvement in visual acuity from the evaluated medical treatments; evidence for corticosteroids, cycloplegics, strict bed rest, and head elevation was limited. Maintain eye protection, pressure monitoring, and close follow-up.[21][22]

Rebleeding commonly occurs during the first week. Increasing pain or reduced vision requires urgent reassessment. Admission or intensified monitoring may be needed for a large or recurrent hyphema, elevated IOP, sickle cell disease or trait, other significant ocular injuries, or difficulty obtaining reliable follow-up. Ophthalmology determines medication, monitoring frequency, and the need for anterior chamber washout.[21]

Retinal Detachment

Trauma can cause retinal tears, retinal dialysis, vitreous hemorrhage, and retinal detachment, sometimes with delayed presentation. New flashes, a sudden increase in floaters, a curtain or shadow in the visual field, or unexplained reduced vision require urgent retinal assessment. A normal external examination or preserved central acuity does not exclude a peripheral tear or detachment.[10]

Document visual acuity, pupils, and confrontation fields. A reduced red reflex or vitreous pigment may increase concern, but a reassuring direct ophthalmoscopic examination cannot exclude peripheral retinal pathology. Arrange same-day ophthalmology evaluation for suspected tear or detachment; marked or progressive visual loss warrants immediate contact and transfer when needed. Definitive assessment requires a dilated retinal examination, with specialist ultrasonography when the view is obscured.[10]

Ocular point-of-care ultrasound with an ophthalmic preset and minimal probe pressure may assist a trained clinician after globe integrity has been established, but it must not delay referral or be used when an open globe is suspected. The commonly cited 2019 multicenter ultrasound study excluded patients with ocular trauma and suspected globe rupture; its diagnostic accuracy cannot be assumed to apply to traumatic retinal detachment. A negative bedside scan does not replace an ophthalmic retinal examination or exclude a retinal tear.[8][23]

Traumatic Optic Neuropathy

Traumatic optic neuropathy (TON) results from direct injury or transmission of force to the optic nerve after craniofacial trauma. Suspect it when vision, color perception, or the visual field is abnormal, particularly with an RAPD in unilateral or asymmetric injury. The optic disc can appear normal initially; absence of an RAPD does not exclude symmetric bilateral injury. Document the findings and obtain urgent ophthalmology assessment alongside the evaluation of associated head and orbital injuries.[9]

First exclude treatable causes of acute visual loss, especially orbital compartment syndrome, an open globe, and retinal injury. Obtain appropriate trauma imaging to assess fractures, hemorrhage, foreign bodies, or a compressive lesion. An optic canal fracture alone does not establish a need for canal surgery. OCS is a distinct emergency requiring immediate orbital decompression when indicated; this treatment should not be confused with optic canal decompression for indirect TON.[9]

Do not begin routine high-dose or megadose systemic corticosteroids, or arrange routine optic canal decompression, for indirect TON. Randomized trials exist, but current evidence has not demonstrated a convincing visual benefit from these treatments. In the CRASH trial, megadose methylprednisolone increased mortality after clinically significant traumatic brain injury; this concern extends beyond patients with documented intracranial hemorrhage. Management of a focal compressive lesion or direct nerve injury requires an individualized specialist decision.[9][24]

Eyelid Laceration

Before repairing an eyelid wound, assess vision and look for associated globe, orbital, and lacrimal injury. If an open globe is suspected, stop lid manipulation, apply a noncontact rigid shield, and obtain urgent ophthalmology care. Do not probe an embedded object or explore deeply through a wound before globe integrity and the extent of injury have been assessed.[8][25]

Seek urgent ophthalmology or oculoplastic evaluation for eyelid margin involvement, a full-thickness wound, visible orbital fat, suspected levator injury or new ptosis, medial canthal or canalicular injury, canthal tendon disruption, tissue loss, or avulsion. Medial wounds and animal bites warrant particular attention to the drainage system; probing and irrigation for canalicular injury are specialist procedures, not routine first-response steps.[25]

A trained clinician may repair a simple superficial skin laceration after associated injury has been excluded. Preserve viable eyelid tissue, avoid unnecessary debridement, and keep cleansing solutions out of the eye. Timing, suture choice, and repair setting depend on contamination, anatomy, associated injuries, and patient cooperation.[25]

For animal or human bites, assess contamination and infection risk, gently clean the wound once ocular safety permits, and obtain specialist input for periocular repair. Moderate or severe facial bite wounds generally warrant early antibiotics covering aerobic and anaerobic organisms; amoxicillin-clavulanate is a common oral choice when appropriate. Assess rabies exposure with local public health authorities after relevant animal bites.[26]

Review tetanus immunization for every eyelid wound, not only bites. Vaccination and, for selected dirty or major wounds, tetanus immune globulin depend on wound type and immunization history. Antibiotics used for a bite or wound infection do not substitute for tetanus prophylaxis.[18]

Referral and Handoff

Contact ophthalmology immediately for suspected open globe, OCS, substantial visual loss, or entrapment with an oculocardiac response. Continue chemical irrigation during arrangements when indicated. Suspected hyphema, retinal tear or detachment, TON, and complex eyelid injury also require urgent ophthalmic assessment, with transfer determined by clinical severity and local capability. Telephone or video consultation can help when specialist examination is not immediately available, but it should not postpone treatment of a clinically evident emergency.[1][2][10][25]

Handoff should include the injured eye, mechanism and time, baseline and current vision, pupil findings, examination limitations, suspected diagnoses, previous ocular surgery, contamination or foreign body risk, relevant medications and allergies, tetanus status, last oral intake, imaging, and treatments with their times and response. After irrigation, report pH and rebound checks. After decompression, report the procedure, serial vision, and IOP when safe.[1][2][8][11]

References

  1. ↑ 1.0 1.1 1.2 1.3 1.4 1.5 1.6 1.7 Joint Trauma System. Eye trauma: initial care. Clinical Practice Guideline ID 03. June 1, 2021; rapid update June 2023. Accessed October 6, 2026. https://jts.health.mil/assets/docs/cpgs/Eye_Trauma_Initial_Care_01_Jun_2021_ID03.pdf
  2. ↑ 2.00 2.01 2.02 2.03 2.04 2.05 2.06 2.07 2.08 2.09 2.10 Murali S, Davis C, McCrea MJ, Plewa MC. Orbital compartment syndrome: pearls and pitfalls for the emergency physician. J Am Coll Emerg Physicians Open. 2021;2(2):e12372. doi:10.1002/emp2.12372.
  3. ↑ 3.0 3.1 Butterfield E, Bolt A, Clare G, et al. Explosive Weapons Trauma Care Collective (EXTRACCT) blast injury clinical practice guideline: ocular trauma. World J Surg. 2026;50(2):289-297. doi:10.1002/wjs.70204.
  4. ↑ 4.0 4.1 Owens PL, Mutter R. Emergency department visits related to eye injuries, 2008: Statistical Brief #112. In: Healthcare Cost and Utilization Project (HCUP) Statistical Briefs. Rockville, MD: Agency for Healthcare Research and Quality; May 2011. https://hcup-us.ahrq.gov/reports/statbriefs/sb112.pdf
  5. ↑ 5.0 5.1 5.2 5.3 5.4 Kuhn F, Morris R, Witherspoon CD, Heimann K, Jeffers JB, Treister G. A standardized classification of ocular trauma. Ophthalmology. 1996;103(2):240-243. doi:10.1016/S0161-6420(96)30710-0.
  6. ↑ Pieramici DJ, Sternberg P Jr, Aaberg TM Sr, et al. A system for classifying mechanical injuries of the eye (globe). The Ocular Trauma Classification Group. Am J Ophthalmol. 1997;123(6):820-831. doi:10.1016/S0002-9394(14)71132-8.
  7. ↑ 7.0 7.1 7.2 7.3 7.4 7.5 7.6 Boyette JR, Pemberton JD, Bonilla-Velez J. Management of orbital fractures: challenges and solutions. Clin Ophthalmol. 2015;9:2127-2137. doi:10.2147/OPTH.S80463.
  8. ↑ 8.00 8.01 8.02 8.03 8.04 8.05 8.06 8.07 8.08 8.09 8.10 8.11 Zhou Y, DiSclafani M, Jeang L, Shah AA. Open globe injuries: review of evaluation, management, and surgical pearls. Clin Ophthalmol. 2022;16:2545–2559. doi:10.2147/OPTH.S372011.
  9. ↑ 9.0 9.1 9.2 9.3 Blanch RJ, Joseph IJ, Cockerham K. Traumatic optic neuropathy management: a systematic review. Eye (Lond). 2024;38:2312–2318. doi:10.1038/s41433-024-03129-7.
  10. ↑ 10.0 10.1 10.2 10.3 Kang HK, Luff AJ. Management of retinal detachment: a guide for non-ophthalmologists. BMJ. 2008;336(7655):1235–1240. doi:10.1136/bmj.39581.525532.47.
  11. ↑ 11.0 11.1 11.2 11.3 11.4 Bizrah M, Yusuf A, Ahmad S. An update on chemical eye burns. Eye (Lond). 2019;33(9):1362–1377. doi:10.1038/s41433-019-0456-5.
  12. ↑ 12.0 12.1 12.2 Yu CY, Diel RJ, Jiang L, Greiner MA. Chemical eye injury: a case report and tutorial. EyeRounds.org, University of Iowa. February 28, 2022. Accessed October 6, 2026. https://webeye.ophth.uiowa.edu/eyeforum/cases/307-chemical-eye-injury.htm
  13. ↑ 13.0 13.1 13.2 Joseph JM, Glavas IP. Orbital fractures: a review. Clin Ophthalmol. 2011;5:95-100. doi:10.2147/OPTH.S14972.
  14. ↑ 14.0 14.1 Parbhu KC, Galler KE, Li C, Mawn LA. Underestimation of soft tissue entrapment by computed tomography in orbital floor fractures in the pediatric population. Ophthalmology. 2008;115(9):1620-1625. doi:10.1016/j.ophtha.2008.02.025.
  15. ↑ Appelbaum RD, Farrell MS, Gelbard RB, et al. Antibiotic prophylaxis in injury: an American Association for the Surgery of Trauma Critical Care Committee clinical consensus document. Trauma Surg Acute Care Open. 2024;9(1):e001304. doi:10.1136/tsaco-2023-001304.
  16. ↑ 16.0 16.1 16.2 McCallum E, Keren S, Lapira M, Norris JH. Orbital compartment syndrome: an update with review of the literature. Clin Ophthalmol. 2019;13:2189–2194. doi:10.2147/OPTH.S180058.
  17. ↑ Patterson TJ, McKinney D, Ritson J, et al. The use of preoperative prophylactic systemic antibiotics for the prevention of endophthalmitis in open globe injuries: a meta-analysis. Ophthalmol Retina. 2023;7(11):972-981. doi:10.1016/j.oret.2023.06.022.
  18. ↑ 18.0 18.1 Centers for Disease Control and Prevention. Clinical guidance for wound management to prevent tetanus. Updated September 8, 2026. Accessed October 6, 2026. https://www.cdc.gov/tetanus/hcp/clinical-guidance/index.html
  19. ↑ Mair J, Bush L, Halliday S, et al. Use of preoperative imaging in open globe injury management: a systematic review. Br J Ophthalmol. 2026;110(7):842-848. doi:10.1136/bjo-2025-327387.
  20. ↑ McMaster D, Bapty J, Bush L, et al. Early versus delayed timing of primary repair after open-globe injury: a systematic review and meta-analysis. Ophthalmology. 2025;132(4):431-441. doi:10.1016/j.ophtha.2024.08.030.
  21. ↑ 21.0 21.1 21.2 21.3 21.4 Miller SC, Meeralakshmi P, Fliotsos MJ, et al. Global current practice patterns for the management of hyphema. Clin Ophthalmol. 2022;16:3135–3144. doi:10.2147/OPTH.S372273.
  22. ↑ 22.0 22.1 22.2 Woreta FA, Lindsley KB, Gharaibeh A, Ng SM, Scherer RW, Goldberg MF. Medical interventions for traumatic hyphema. Cochrane Database Syst Rev. 2023;3:CD005431. doi:10.1002/14651858.CD005431.pub5.
  23. ↑ Lahham S, Shniter I, Thompson M, et al. Point-of-care ultrasonography in the diagnosis of retinal detachment, vitreous hemorrhage, and vitreous detachment in the emergency department. JAMA Netw Open. 2019;2(4):e192162. doi:10.1001/jamanetworkopen.2019.2162.
  24. ↑ Roberts I, Yates D, Sandercock P, et al; CRASH trial collaborators. Effect of intravenous corticosteroids on death within 14 days in 10008 adults with clinically significant head injury (MRC CRASH trial): randomised placebo-controlled trial. Lancet. 2004;364(9442):1321–1328. doi:10.1016/S0140-6736(04)17188-2.
  25. ↑ 25.0 25.1 25.2 25.3 Clark TJE, Shriver EM. Emergent evaluation of eyelid lacerations: a guide for ophthalmology residents. EyeRounds.org, University of Iowa. January 4, 2016. Accessed October 6, 2026. https://eyerounds.org/tutorials/Eyelid-lacerations/index.htm
  26. ↑ Stevens DL, Bisno AL, Chambers HF, et al. Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the Infectious Diseases Society of America. Clin Infect Dis. 2014;59(2):e10–e52. doi:10.1093/cid/ciu296.
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