| Mechanical injury to the globe | Normal or damaged cornea; moderate to severe pain; normal or decreased vision; hyphema; red eye/subconjunctival hemorrhage in the area 360 degrees around the cornea | Decreased anterior chamber depth relative to uninjured eye; irregular or deviated pupil toward the direction of injury; positive Seidel test | Eye shield |
| Tonometry contraindicated |
| Leave embedded foreign object in place |
| Scheduled analgesia and antiemetics; update tetanus immunization |
| Immediate referral to an ophthalmologist |
| Chemical injury | Cornea may have minor epithelial damage or be opaque; moderate to severe pain; blurred vision; reflex blepharospasm; photophobia; sensation of a foreign body; red eye/conjunctiva | Findings depend on the severity; corneal and scleral melting may occur if injury is severe | Eye irrigation with normal saline or lactated Ringer's solution until pH is normal |
| Continue eye wash on way to the emergency department or an ophthalmologist |
| Central retinal artery occlusion | Clear cornea; amaurosis fugax (transient, painless unilateral vision loss) or permanent vision loss; red eye/conjunctiva | Interrupted columns of blood within the retinal vessels (sometimes referred to as “boxcarring”) and attenuation of retinal arteries; cherry-red spot at the fovea; pale fundus; pupil may be dilated and react poorly to light | Lowering IOP with mannitol (Osmitrol) 0.25 to 2.0 g per kg IV once, acetazolamide (Diamox*) 500 mg IV or orally once, carbogen inhalation, administering oral nitrates, or by laying the patient on his or her back |
| Ocular-digital massage |
| Immediate referral to an ophthalmologist |
| Acute angle-closure glaucoma | Acute onset of severe pain; blurred vision; frontal headache; halos around lights; increased IOP; red eye/conjunctiva | Mid-dilated and sluggish pupil; normal or hazy cornea; shallow anterior chamber | Lowering IOP with acetazolamide 500 mg orally once; and one drop each of 0.5% timolol maleate (Timoptic), 1% apraclonidine (Iopidine), and 2% pilocarpine (Isopto Carpine) one minute apart and repeated three times at five-minute intervals |
| Immediate referral to an ophthalmologist |
| Retinal detachment | Normal to peripheral or central vision loss; absence of pain; increasing floaters; unilateral photopsia; metamorphopsia | Normal conjunctiva and cornea; normal pupil; pale, detached retina | Antitussives or antiemetics (if needed) |
| Referral to an ophthalmologist within 24 hours |