A complete eye exam should be conducted
Eyelid Exam
Flip upper lid and exam lower lid for foreign body
If concern for foreign body despite normal exam, consider orbital CT or MRI if certain foreign body is nonmetallic
Fluorescein Exam
Apply 1 gtt of flourescein or use strip with anesthetic
Use Wood's lamp or slit lamp with cobalt blue light
Fluorescein will fill<unk>  defects and glow
Multiple vertical<unk> s suggests foreign body embedded under the upper lid
Topical anesthetic (ie proparacaine or tetracaine) may assist in patient cooperation with exam once open globe excluded.
Repeated doses or Rx for topical anesthesia is controversial given concerns for impaired healing
Flip upper lid and exam lower lid for foreign body
If concern for foreign body despite normal exam, consider orbital CT or MRI if certain foreign body is nonmetallic
Apply 1 gtt of flourescein or use strip with anesthetic
Use Wood's lamp or slit lamp with cobalt blue light
Fluorescein will fill<unk>  defects and glow
Multiple vertical<unk> s suggests foreign body embedded under the upper lid
Repeated doses or Rx for topical anesthesia is controversial given concerns for impaired healing
Contact lens wearer
If white spot or opacity on exam concerning for infiltrate or<unk>  ulcer refer for same day ophtho appt
Fluorescein Examination
Seidel sign (streaming of fluorescein) indicates penetrating trauma
Branching/Dendritic pattern suggests possible Herpes Zoster Ophthalmicus
Visual acuity
If poor, consider<unk>  edema versus infectious infiltrate
Pupil shape and reactivity
Irregular or nonreactive pupil suggests pupillary sphincter injury and possible penetrating trauma
Hyphema or hypopyon
Hyphema suggests possible penetrating injury
If present then same same-day ophtho consult is required
Extruded ocular contents
If yes then place eye shield and obtain emergent ophtho referral<unk>  Ulcer
Grayish white lesion
Worsening symptoms >1day
If white spot or opacity on exam concerning for infiltrate or<unk>  ulcer refer for same day ophtho appt
Seidel sign (streaming of fluorescein) indicates penetrating trauma
Branching/Dendritic pattern suggests possible Herpes Zoster Ophthalmicus
If poor, consider<unk>  edema versus infectious infiltrate
Irregular or nonreactive pupil suggests pupillary sphincter injury and possible penetrating trauma
Hyphema suggests possible penetrating injury
If present then same same-day ophtho consult is required
If yes then place eye shield and obtain emergent ophtho referral
Grayish white lesion
Worsening symptoms >1day
Corneal abrasion
Nontraumatic
Conjunctival abrasion
Acute angle-closure glaucoma^
Corneal ulcer
Anterior uveitis
Subconjunctival hemorrhage
Conjunctivitis