Goals

Prevent further damage to the eye, prevent infection in the eye (endophthalmitis), and evacuate to an eye surgeon as soon as possible.

Minimum

- Maintain high suspicion for OGI; treat any suspected open globe as an open globe until surgical exploration is available.
- Obtain and record visual acuity from the injured and noninjured eye.
- Apply a rigid eye shield without any type of gauze or bandaging under the shield to prevent further damage, per TCCC guidelines.4
- Initiate endophthalmitis prophylaxis with moxifloxacin 400mg PO daily or levofloxacin 750mg PO daily; if intravenous (IV) administration is necessary, ertapenem 1g IV or intraosseously (IO) daily.5 Initiate pain control as needed.
- Initiate antiemetic (ondansetron 4mg oral dissolving tablet [ODT] IV/IO or intramuscularly [IM] every 8 hours as needed).
- Raise head 30°–45°.
- Activate evacuation with the goal of surgery within 24 hours.
- Initiate teleconsultation with photographs.

Better

- Minimize patient movements; maintain supine position with head at 30°–45°.
- Maintain endophthalmitis prophylaxis with an additional dose of moxifloxacin 400mg PO daily or levofloxacin 750mg PO daily; if IV administration is necessary, ertapenem 1g IV/IO daily and the addition of clindamycin 300mg PO or IV every 8 hours if available; this is to cover Bacillus cereus, a particular concern in contaminated OGI.6
- Maintain antiemetic and pain control.

Best

- Perform a detailed ocular evaluation to include visual acuity and RAPD, and note any suspicious findings.
- Evaluation should be repeated with any reported change in vision or pain level by the patient. If symptoms are stable, perform ocular evaluation every 4 hours and before transfer.

Initiate real-time video telemedicine consultation.

- Coordinate surgical care within 8 hours of injury.
- No altitude restrictions are required for OGIs.

NOTES:

- Ultrasound is contraindicated for suspected OGI because it places pressure on the eye.
- Rigid eye shields are available in several different designs. Fit should be checked to ensure protection without any pressure on the eye. Standard eye protection may also be used to shield the injured eye.

Photographs by COL Mark Reynolds.