Eye trauma
When Is Ophtho Discussion Reasonable for Eye Trauma?
A concise clinician guide for eye trauma, open-globe concern, high-velocity mechanism, hyphema, intraocular foreign body concern, lid injury, and orbital entrapment.
Quick answer
Eye Trauma Triage
- Ophtho discussion is reasonable for suspected open globe, penetrating injury, high-velocity metal/glass/organic material, severe vision change, hyphema, abnormal pupil, IOFB concern, lid-margin/canalicular injury, or orbital fracture with entrapment concern. [1]
- Trauma, OMFS, ENT, neurosurgery, or transfer pathways may be first or concurrent when polytrauma, facial fracture, intracranial injury, source-control, or operative routing dominates.
- If open globe is possible, avoid pressure on the eye: do not measure IOP, do not patch with pressure, and avoid manipulating the globe to complete an exam.
Ophtho discussion is reasonable when
Higher-Risk Features
- Mechanism suggests penetrating injury, high-velocity projectile, metal/glass, organic material, or intraocular foreign body.
- Visual acuity is decreased, APD is present, pupil is peaked/irregular, hyphema is present, or globe contour is abnormal.
- Laceration involves the lid margin, medial canthus/canaliculus, or there is concern for retained foreign body.
- Diplopia, restricted EOM, pain with EOM, proptosis, decreased vision, or orbital fracture/entrapment concern is present.
Workup or other service first when
Better First Step
- The patient has major trauma physiology, airway/bleeding concern, intracranial injury, or facial trauma requiring immediate trauma/surgical stabilization.
- The missing information is mechanism, timing, OD/OS visual acuity, APD/pupils, EOM, hyphema, fluorescein findings, or CT orbit/face findings when imaging is part of local workflow.
- The injury is low-risk foreign body or minor irritation without visual change, abnormal pupil, hyphema, high-velocity mechanism, penetrating concern, or orbital signs.
Common pitfall
Do Not Create Globe Pressure
If open globe is on the table, the missing IOP number is less important than avoiding pressure and clearly communicating mechanism, visual acuity, pupil shape, hyphema, and globe-integrity concern.
FAQ
Clinician Questions
What details matter most for eye trauma?
Mechanism, timing, OD/OS visual acuity, APD/pupils, EOM restriction, hyphema, fluorescein/Seidel concern if safely assessed, lid/canalicular involvement, and imaging status when applicable.
Should I get IOP in eye trauma?
Only when it is safe. If open globe or penetrating injury is possible, avoid pressure on the eye and do not measure IOP just to complete documentation.
Who else may need to be involved?
Depending on the injury: trauma, OMFS, ENT, neurosurgery, radiology, transfer center, or ED/local emergency pathway may be concurrent with Ophtho.
References
Educational tool only. SIC provides clinician-facing educational consult-triage references. SIC does not diagnose, treat, prevent, cure, or mitigate disease and is not a substitute for clinical judgment, local guidelines, institutional referral pathways, or recommendations from your Ophthalmology department. See disclaimer.