Eye Trauma & Chemical Injury
Provide safe initial recognition and escalation for chemical, blunt and penetrating injury.
Quick revision ↓ Medical Dictionary
01Mechanism first
Ask about high-velocity metal, sharp objects, blunt impact, chemical exposure and protective equipment. Treat associated life-threatening injuries in parallel. Record visual function when feasible without delaying urgent care. A small external wound does not exclude a penetrating injury or retained foreign body. Do not manipulate an embedded object or press on a potentially open globe.
02Chemical exposure
For an isolated chemical splash without suspected penetration, begin immediate copious irrigation using an appropriate available fluid, including clean water if necessary, while arranging emergency care. Do not wait for a full history or a preferred fluid. Trained staff assess pH and retained material and continue care to the appropriate endpoint. Do not attempt chemical neutralisation with another reactive substance.
03Suspected open globe
A distorted pupil, visible wound, tissue prolapse or high-risk mechanism can suggest an open globe. Avoid pressure, patching that compresses the eye, tonometry and removal of an embedded object. Protect with a rigid shield and arrange emergency ophthalmic care. Combined chemical and penetrating injury requires immediate expert guidance; avoid forceful irrigation devices or pressure-producing manipulation.
04Blunt injury and hyphaema
Blood in the anterior chamber after trauma requires urgent eye assessment for pressure problems and associated injury. Examine only within safe limits and document the mechanism. Orbital fracture, retinal injury and lens displacement may coexist. A transient return of useful vision does not exclude serious pathology, and follow-up may be needed for delayed pressure or retinal complications.
05Foreign bodies and prevention
High-speed metal work can produce an intraocular foreign body despite a subtle surface mark. Imaging is selected by the specialist team; MRI is avoided when a metallic intraocular foreign body is possible. Review tetanus status and antimicrobial needs through the trauma pathway. Emphasise appropriate eye protection and a clear return plan after any apparently minor injury.
High-Yield Revision
- Chemical irrigation must not await a preferred fluid in an isolated splash.
- Suspected open globe: shield, avoid pressure and obtain emergency help.
- High-velocity metal injury can hide an intraocular foreign body.
Common Pitfalls
- Removing an embedded object without specialist care.
- Using MRI before excluding a metallic intraocular foreign body.
References & Further Reading
Read the relevant guideline sections alongside these original clinical teaching cases. Local pathways, available services and individual patient factors determine care.
Reference review: 28 September 2026. Consult current local protocols for prescribing, procedures and escalation.