The ABCs of Ocular Trauma: Adapting a Familiar Mnemonic for Rapid Eye Exam in the Pre-Ophthalmic Zone of Care

Abstract

Evaluation and management of eye trauma is daunting to many practitioners. For general medical emergencies, the familiar ABCs mnemonic serves to both recompose the provider as well as provide a logical order for evaluation and action. We recently adapted an ABCs mnemonic to provide non-ophthalmologists with a familiar method for systematically evaluating and managing eye trauma. A = ACUITY. Visual acuity is the most importance piece of information in eye trauma. B = BEST exam of BOTH eyes. Starting with acuity, examination proceeds from the front to the rear of the eye. Examine the uninjured eye first. C = CONTIGUOUS STRUCTURES and CONTACT LENSES. Examine structures contiguous to the apparent injury. Inspect for contact lens wear. D = DRUGS, DIAGNOSTIC IMAGING, and the DON’TS. Start antibiotics, antiemetics, and analgesics. Administer tetanus. Obtain computerized tomography if available. Do not attempt ocular ultrasound or magnetic resonance imaging. Do not apply pressure to the eye. Do not patch the eye or apply any medication. E = EYE SHIELD and EVACUATE. Shield and ship to ophthalmology. The mnemonic was adapted to reflect current Joint Trauma Services and Tactical Combat Casualty Care practice guidelines. We believe this familiar mnemonic will serve as a useful tool in allowing non-ophthalmologists to comfortably and safely evaluate an eye for trauma.

Ocular Blast Injuries in Military and Civilian Mass-casualty Settings

“…It is essential that an ophthalmologist member of the team evaluates all patients with suspected ocular blast injury. 24 The initial task of the first-responder ophthalmologist must be to identify those patients requiring urgent lifesaving interventions. Ocular injuries from blast trauma most often do not occur in isolation, 24 so it is important to perform a full-body, unclothed survey to identify all injuries.…”

“…24 The initial task of the first-responder ophthalmologist must be to identify those patients requiring urgent lifesaving interventions. Ocular injuries from blast trauma most often do not occur in isolation, 24 so it is important to perform a full-body, unclothed survey to identify all injuries. When possible, a brief history can be high-yield in determining the site of the blast and the composition of shrapnel.…”

“…26,27 Initial vision testing is imperative as vision may not be checked again for several days in patients requiring sedation or intensive care unit stays for severe injuries. 24 The eyes should then be examined from front to back. If available, examination of the anterior segment with a slit lamp biomicroscope is ideal, but a handheld penlight can also be effective.…”

“…28 If there is suspicion of retrobulbar hemorrhage causing orbital compartment syndrome, which may manifest with decreased VA, "rock hard" eyelids, proptosis, or relative afferent pupillary defect, a low threshold should be maintained to perform prompt lateral canthotomy and inferior cantholysis to relieve pressure on the globe. 24 Other interventions for nonemergent ophthalmic injuries can be postponed until the patient is stable or scheduled for a later date.…”

“…It is essential that an ophthalmologist member of the team evaluates all patients with suspected ocular blast injury 24 . The initial task of the first-responder ophthalmologist must be to identify those patients requiring urgent lifesaving interventions.…”