In the first hours after a blast or projectile injury, well-meant first aid can make an open globe worse. Pressure from a pad or an examining finger can extrude intraocular contents.
If the history suggests penetration, or you see a peaked pupil, prolapsed tissue, a very deep or shallow anterior chamber or 360-degree subconjunctival haemorrhage, protect the eye with a rigid shield and refer urgently.
- Use a rigid shield resting on the orbital rim, not a pressure pad.
- Do not measure intraocular pressure or evert the lids.
- Give antiemetics and analgesia to prevent straining and vomiting.
- Keep the patient nil by mouth and check tetanus status.
Why it matters
Pressure on an open globe in the first hours can turn a repairable injury into a lost eye.
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