Scratches & Stains
When preparing to stain a cornea for a suspected scratch, the technician applies this paper diagnostic strip into the inferior fornix tear lake before illuminating with a cobalt blue filter.
What is a Fluorescein Sodium ophthalmic strip?
During patient history intake downrange, the technician asks if the patient was using an angle grinder, hammering armor, or caught in an explosion, because high-speed metal shrapnel can pierce the cornea with this deceptive symptom.
What is minimal initial pain (or a micro-puncture entrance that seals quickly)?
In an acute battery acid or caustic chemical splash, the technician knows this standard intake step must be completely skipped until continuous irrigation has begun.
What is Visual Acuity testing (or medical history intake)?
This rigid, perforated aluminum dome resting strictly on the brow and zygoma is the single most critical intervention a technician applies to protect a ruptured eye from accidental pressure.
What is a rigid Fox Eye Shield?
The technician must give this strict, immediate safety instruction to every casualty suspected of having an orbital blowout fracture to prevent sinus air from blowing into the orbit.
What is "DO NOT BLOW YOUR NOSE"?
If an intake patient presents with vertical, parallel scratches resembling an "ice rink" across the corneal center, the technician must immediately perform this physical manipulation to locate the foreign particle.
What is the upper eyelid (searching for a subtarsal foreign body)?
If an intake note records suspicion of metallic eye shrapnel, the technician must immediately place a prominent safety flag warning the trauma team that this common imaging study is STRICTLY CONTRAINDICATED.
What is an MRI (Magnetic Resonance Imaging)?
A technician tests the casualty's lower fornix with litmus paper upon arrival and gets a pH of 11.0 (deep blue/purple). State whether this is an acid or alkali burn, and state which is more hazardous.
What is an Alkali (basic) burn, which is far more destructive due to liquefactive necrosis?
During penlight triage, you observe a pupil shaped like a teardrop or pear. The pointed end of the teardrop pupil points directly toward this feature.
What is the corneal or limbal laceration / open-globe wound site?
When testing basic extraocular motility during triage, you notice the casualty's injured eye cannot look upward and they report sudden double vision. Name the muscle trapped in the fractured orbital floor.
What is the Inferior Rectus Muscle?
A technician should NEVER dispense a bottle of Proparacaine or Tetracaine to a patient for self-administration for this toxic reason.
What is repeated use causes corneal epithelial melting, toxic keratopathy, and permanent ulceration?
While performing a penlight inspection on a shrapnel casualty, you note a localized iris transillumination defect. Explain what this red glow through the iris indicates to the technician.
What is a full-thickness penetration through the iris caused by an intraocular foreign body?
This specialized plastic ocular delivery device snaps onto standard IV administration tubing, seats under the eyelids, and provides continuous, hands-free corneal lavage.
[DAILY DOUBLE]:
What is a Morgan Lens?
When inspecting a ruptured eye, you spot dark brown, jelly-like tissue resembling "raisin skin" protruding through a white scleral wound. The technician immediately identifies this as herniation of this tissue layer.
What is the Uveal tract (iris, ciliary body, or choroid)?
When palpating the orbital rim and swollen eyelids of an orbital fracture patient, the technician feels a crackling, rice-krispie sensation under the skin known by this medical term.
What is Subcutaneous Emphysema (or Crepitus)?
When discharging a basic, non-infected corneal abrasion patient, technicians must ensure the eye is NOT taped shut with this traditional dressing because it deprives tissue of oxygen and increases infection risk.
What is a pressure patch (or tight-fitting eye pad)?
This non-invasive radiological exam is the gold standard that the technician verifies is ordered for every penetrating ocular shrapnel casualty.
What is a non-contrast CT scan of the orbits (axial and coronal thin cuts)?
Before you can report to the provider that chemical irrigation is complete, you must turn off the fluid, wait 5 minutes, and verify that conjunctival pH testing falls in this neutral window.
What is pH 7.0 to 7.5?
Name the diagnostic procedure using an electronic Tono-Pen that a technician is STRICTLY FORBIDDEN from performing on any suspected open globe casualty.
What is Tonometry (measuring intraocular pressure)?
While screening facial sensation, the patient reports that their upper lip, side of the nose, and front teeth are completely numb. Name the sensory nerve injured in the orbital floor.
What is the Infraorbital Nerve?
A deployed military working dog handler or warfighter wearing contact lenses sustains an abrasion. In your intake note, you flag that standard erythromycin ointment is insufficient because this contact lens associated pathogen must be covered by fluoroquinolone drops.
What is Pseudomonas aeruginosa (requiring a fluoroquinolone like Ciprofloxacin or Ofloxacin)?
When staging a casualty with a suspected intraocular foreign body for flight evacuation, the technician must secure this specific rigid device over the eye and enforce this head elevation angle.
What is a rigid Fox shield and 30-degree head elevation?
To ensure no hidden granules of concrete, lye, or chemical powder remain trapped in tissue folds, the technician moistens a cotton applicator and assists by performing this procedure on the upper and lower lids.
What is sweeping (or debriding) the conjunctival fornices?
When preparing an open-globe casualty for emergency transport, the technician administers or assists in giving Ondansetron (Zofran) for this specific reason.
What is to prevent nausea/vomiting, which creates a Valsalva pressure spike that forces intraocular contents out of the eye?
In pediatric casualties or young service members, a trapped inferior rectus muscle can trigger bradycardia, severe nausea, and syncope via this life-threatening cranial nerve reflex.
What is the Oculocardiac Reflex (Trigeminovagal reflex)?