Foreign bodies can be removed in A and E, minor injuries and by optometrists. First instill some topical oxybuprocaine and then wipe away with a sterile cotton bud. If unable to remove it using this method please refer to the eye pavilion.
Please prescribe chloramphenicol ointment to use for 3-5 days following removal or until review at the eye Pavilion.
Trauma with reduced vision should be referred for fundal assessment. Severe blunt orbital trauma can lead to a retro-orbital haematoma. This gives similar symptoms of optic neuritis as the optic nerve function can be compromised. It is an emergency and the orbit needs urgent decompression. Signs of optic nerve involvement include: decreased vision, abnormal pupils (RAPD), decreased ocular motility and decreased colour vision.
An abrasion is a scratch to the superficial corneal layer. It will show up with fluorescein. There is usually a history of something scratching to the eye. Common causes include fingernails and tree branches. Supply chloramphenicol ointment 1% to be used four times a day for 1 week.
Following healing lubricants should be commenced and continued for 3-6 months to prevent recurrent erosion syndrome. A typical regime could be lacrilube at night and carbomer gel 4 times a day.
Recurrent erosion can occur following an abrasion and is more common in patients with dry eyes e.g. after LASEK/LASIK eye surgery to correct myopia (short sightedness). The abrasion heals but leaves an area of weakness. Overnight our tear film is less and on wakening the fragile surface epithelium at the old abrasion site can lift off/be disturbed and cause intense pain. To prevent it from occurring patients who have corneal abrasions should be informed of the risk and encouraged to use lubricants to the eye for the next 3-6 months after the abrasion.
A typical history
is a sudden sharp pain causing epiphora and photophobia immediately on waking.
| Condition | How Soon | Additional Information |
| Corneal foreign body | Urgent | Attend optometrist/accident and emergency for removal. If unsuccessful refer to ophthalmology |
| Blunt trauma | Urgent | |
| Penetrating eye injury/globe rupture | Emergency | |
| Chemical injury | Emergency | Immediate irrigation in primary care by GP/optometrist/A and E |
| Retro-orbital haemorrhage | Emergency | |
| Eyelid laceration | Urgent | |
| Corneal abrasion | Urgent | Manage in primary care.Use of lubricants following the abrasion is important to prevent recurrent erosion syndrome. |
| Welders flash | Urgent | Consider optometrist management |
Who to refer:
Please see Lothian GP and optometry ophthalmology referral pathway.
Urgency of the condition for details on how soon patients should receive an appointment.
How to refer:
We require a referral letter for EVERY patient.
The preferred referral process is via SCI Gateway. If sending/forwarding a referral via SCI gateway please include past medical history, allergies and medications
If you do not have access to fax or SCI Gateway e.g. if you have arranged an appointment out of hours please send a written referral letter with the patient to bring to their appointment.
Only if SCI Gateway is unavailable should a letter be typed or handwritten. Please write legibly and include your examination findings.
If you have arranged an appointment in the acute referral clinic and you are referring from within another hospital in Lothian please use TRAK to type the referral letter.
