Continuing Education Activity

Ocular trauma poses a significant public health concern, ranging from workplace accidents to sports-related injuries, with potential consequences varying from complete recovery to irreversible blindness. This CME activity delves into essential strategies for preventing ocular trauma and emphasizes the crucial role of patient counseling in promoting eye safety. The discussion covers protective eyewear tailored to specific activities, education on potential risks, and advocating for safety measures in various settings, including workplaces, schools, and homes. Healthcare professionals, educators, employers, and parents play pivotal roles in reducing the incidence of eye injuries. The content explores the types and epidemiology of ocular trauma and underscores the importance of an interprofessional approach in evaluating, managing, and mitigating the risk of visually significant ocular injuries. By fostering awareness and encouraging the adoption of preventive measures, this activity aims to empower individuals and communities to protect their most precious sense: vision.

Objectives:

• Identify the mechanisms of ocular trauma and their sequelae.
• Determine the epidemiology of ocular trauma and resulting complications.
• Apply methods and guidelines to reduce the risk of severe ocular trauma and to triage traumatic injuries appropriately.
• Compare recommendations and counseling strategies to reduce the risk of blindness in monocular and other high-risk patients.

Introduction

The consequences of ocular trauma range from complete recovery to irreversible blindness, with or without loss of the eye. Trauma is the most common cause of noncongenital unilateral blindness in children.[1] The US government and World Health Organization define blindness as best-corrected visual acuity worse than 20/400.[2] Vision loss after trauma is typically defined as best-corrected visual acuity less than 20/40, visually significant scotomas, visual field defects, or loss of contrast sensitivity. Depending on the mechanism of injury, initial symptoms of ocular trauma vary and include pain, burning, acute loss of vision, diplopia, and physical disfigurement. Ocular trauma, or eye injury, can result from various causes, including accidents, sports injuries, workplace incidents, and everyday activities. These injuries can have severe and lasting consequences, affecting a person's vision and overall quality of life.[3]

Fortunately, many ocular injuries can be prevented by implementing appropriate strategies and patient counseling. In this discussion, we will explore the importance of ocular trauma prevention and the role of patient education in reducing the risk of eye injuries. We will examine various strategies and precautions that can be taken to safeguard the eyes in different settings and scenarios.[4] Individuals can significantly reduce their chances of experiencing ocular trauma by understanding the potential risks and taking proactive measures. Ocular trauma encompasses a wide range of injuries, from minor irritations and corneal abrasions to more severe injuries, such as penetrating wounds and blunt trauma.

Each type of injury requires specific preventive measures and may have different implications for long-term eye health.[5] This discussion aims to inform healthcare professionals, patients, and the general public about the importance of ocular trauma prevention and provide practical guidance on minimizing the risk of eye injuries. By promoting awareness and advocating for safe practices, we can work together to protect our most valuable sense—our vision. This article will discuss the types of ocular trauma, epidemiology, risk factors, national trends, practice patterns, prognosis, and prevention while emphasizing patient counseling. Understanding ocular anatomy, types of ocular trauma, and the variety of inciting events and sequelae is essential to assess appropriately, triage, manage, and ultimately reduce morbidity, blindness, and recurrence.

Function

Function of Ocular Trauma Prevention Strategies and Patient Counseling:

Prevention of Ocular Trauma: The primary function of ocular trauma prevention strategies and patient counseling is to reduce the incidence of ocular injuries. This includes damage to the eye or the surrounding structures, which can result from various causes such as accidents, sports-related activities, workplace hazards, or domestic incidents.[6]

Preservation of Vision: Another critical function is to preserve and protect the vision of individuals. Ocular trauma can lead to partial or complete loss of vision, and effective prevention measures aim to minimize the risk of such outcomes.[6]

Education and Awareness: Patient counseling plays a key role in educating individuals about the potential risks of ocular trauma and the steps they can take to prevent it. This includes raising awareness about the importance of eye safety in various settings, such as the home, sports, or industrial environments.[7]

Risk Assessment: Healthcare providers should assess patients' specific risks based on their activities, occupation, and lifestyle. For example, individuals involved in contact sports may have a higher risk of ocular trauma, so they need tailored counseling and strategies.[8]

Protection Strategies: Providing patients with practical strategies and recommendations for eye protection is essential. This might involve recommending safety glasses, goggles, or helmets for specific activities or occupations where eye injuries are more likely to occur.[9]

First Aid and Immediate Action: Patients should be educated on appropriate first aid measures to take in the event of an ocular injury. Knowing what to do immediately after an injury can significantly impact the outcome and may prevent further damage.[10]

Regular Eye Examinations: Encouraging patients to schedule regular eye examinations is essential. These examinations can help identify potential eye conditions or issues that may increase the risk of trauma, such as poor vision or eye diseases.[11]

Promoting Safety Culture: In workplace settings, patient counseling and prevention strategies should create a safety culture where employees are encouraged to use protective gear, follow safety protocols, and report hazards.[12]

Advocacy and Policy Support: Advocating for policies and regulations that promote eye safety, such as mandatory safety standards for protective eyewear in specific industries or sports, is part of the broader function of ocular trauma prevention.[12]

Research and Data Collection: Continuously gathering and analyzing data on ocular trauma incidents is essential for refining prevention strategies. This can help identify trends, high-risk groups, and areas where additional interventions are needed.[13]

Overall, the function of ocular trauma prevention strategies and patient counseling is to minimize eye injuries, reduce their severity when they occur, and ultimately preserve individuals' visual health and well-being.

Issues of Concern

Types of Ocular Trauma

Chemical exposure to the ocular surface results in a variable degree of injury, depending on the type of exposure. Identifying the time course, degree of exposure, and pH of the causative agent is essential. Alkali injuries, which often occur in the home, workplace, or rarely as a weapon of assault, are especially devastating. They can cause permanent blindness despite rapid treatment due to the ability of alkalis to penetrate deeply into the ocular tissue. On the other hand, acids denature proteins, forming a barrier to prevent further penetration. Concurrent chemical and mechanical injuries are possible, and it is important not to overlook chemical exposure during the emergency evaluation of ocular injuries.[14]

Thermal and UV exposure can lead to severe keratitis, corneal melt, and future ocular surface dysfunction and disfigurement. Although less common, they can result from exposure to household appliances such as curling irons, UV light exposure from UV-disinfectant lights or solar exposure, fire-related injuries, and welding or other occupational injuries. In cases of severe periocular burns or systemic burns with rapid fluid resuscitation, dramatic increases in intraorbital pressure can lead to vision-threatening orbital compartment syndrome.[15] 

Mechanical globe trauma can be characterized as either blunt or lacerating trauma. Blunt trauma is the most common type of ocular trauma and occurs after either direct or indirect impact to the globe or orbit. Common causes include motor vehicle crashes with concurrent head injuries or airbag deployment, falls, physical assault, and sports-related injuries. Blunt trauma with globe contusion can result in subconjunctival hemorrhage, hyphema, commotio retinae, retinal or vitreous hemorrhage, and even retinal tears or detachment. On the other hand, lacerating globe trauma occurs with either direct contact with sharp objects or from the transmission of forces resulting in avulsion or rupture of structures.[16]

Small subconjunctival hemorrhages without other globe injuries typically self-resolve without intervention.[17] A diffuse bullous subconjunctival hemorrhage should raise suspicion for deeper globe injury, including laceration or open-globe injury.

The presence of a hyphema, or bleeding in the anterior chamber of the eye, typically results from damage to the microvasculature of the iris. A hyphema can rarely represent blood collection from bleeding in the posterior chamber. Initial management includes eye shielding, maintaining an upright position, and prompt ophthalmology referral.[18]

Vitreous hemorrhage, or bleeding in the posterior chamber, typically presents with acute vision loss due to obscuration of the fundus.[19] Underlying retinopathy in the setting of diabetes or sickle cell disease increases the risk of vitreous hemorrhage after trauma. Vitreous hemorrhage in young and myopic patients without underlying retinopathy should raise suspicion for an underlying retinal tear.

Following a break in the retina, subsequent detachment of the neurosensory retina from the underlying retinal pigment epithelium can occur, resulting in a rhegmatogenous retinal detachment.[20] The fundus exam classically shows a raised, corrugated retinal appearance with subretinal fluid. Prompt surgical repair is needed to preserve vision, with improved outcomes expected when the repair is done before macular detachment.

Corneal abrasions are superficial injuries ranging from small epithelial defects that resolve spontaneously to visually significant lesions with subsequent development of infection, scarring, or astigmatism.[21] In contrast, corneal lacerations are a type of open globe injury that requires urgent surgical management.[22][23] Corneal lacerations are often accompanied by flattening of the anterior chamber, pupil peaking, and iris plugging.

Similarly, conjunctival abrasions are self-limited, contrasting with conjunctival lacerations, which may require surgical repair if large.

Scleral lacerations require surgical repair and further exploration, given the risk of penetrating globe injury. A globe rupture is an ocular emergency requiring prompt ophthalmology evaluation and surgical exploration.[16] An intraocular foreign body should be suspected based on the mechanism of injury, and CT imaging is helpful to evaluate for metallic foreign bodies or suspicious patterns of globe malformation.[24]

Trauma to the orbital and periorbital structures can occur with or without an open globe injury. Understanding this intricate anatomy is important during the initial evaluation when the clinical exam must be used with imaging to diagnose and treat patients appropriately.

In addition to eyelid lacerations, which are common traumatic injuries requiring knowledge of anatomy and meticulous repair, canalicular injuries are less obvious consequences of periocular trauma. They occur most often following assault in adults and dog bites in children.[25][26] Canalicular injuries can arise from both direct and indirect trauma with stretching of the eyelid to the point of avulsion.[27][28] Surgical repair is often required, especially in cases involving both upper and lower canaliculi, given the increased incidence of long-term epiphora and anatomical distortion. Damage to the medial or lateral canthal tendons can occur alongside canalicular injuries, especially in avulsive and lacerating injuries.

Orbital fractures frequently occur in the setting of additional facial trauma and, depending on the situation, require a multidisciplinary team of ophthalmologists, otolaryngologists, maxillofacial surgeons, and neurosurgeons. When the orbital rim is struck, the compression and transmission of intraorbital pressure can lead to a fracture at the weakest point, typically the orbital floor or medial wall. This is called a “blowout fracture.”[29]

A clinical exam is essential in conjunction with imaging to evaluate for signs of muscle entrapment, including eye deviation, restricted extraocular movements, bradycardia, nausea, and dizziness. Extraocular muscle entrapment requires urgent surgical correction to prevent muscle strangulation, necrosis, and further complications. Orbital roof fractures are less common and typically occur with more severe facial trauma.[29]

Neurosurgical evaluation is required to evaluate for complications, including cerebrospinal fluid leaks, pneumocephalus, and concurrent intracranial pathology. Imaging is an important part of the initial evaluation and can suggest more severe globe injuries that require intervention. Assessment of all orbital fractures requires a thorough clinical exam to rule out globe injury and extraocular muscle entrapment is essential. It should be used in conjunction with imaging to guide treatment.[30]

The most common cause of traumatic diplopia is extraocular muscle entrapment following an orbital fracture. In children and young adults, inferior rectus entrapment can occur without an obvious fracture on CT when an inferior fracture recoils back to its position with minimal displacement, resulting in a “trapdoor” fracture when the muscle is caught within the bony defect. Given the relative lack of other physical exam findings, many trapdoor fractures are also called “white-eyed blowout fractures.”[31] EOM entrapment is a clinical diagnosis, and urgent surgical repair is indicated in most situations. In addition to entrapment, EOMs can be transected, avulsed, or retracted.[32] Understanding orbital anatomy is needed to identify and appropriately repair such injuries.

Table

Types of Ocular Trauma                                              (more...)

Retrobulbar hemorrhage is a potentially vision-threatening consequence of orbital trauma that requires early diagnosis and treatment. It commonly occurs in the setting of orbital fractures and can be incidentally noted on CT.[33] Significant collections due to severe trauma or systemic anticoagulation can lead to clinical findings of orbital compartment syndrome, including compressive optic neuropathy, proptosis, EOM restriction, and elevated intraocular pressure. The risk of permanent blindness is higher in retrobulbar bleeding in the setting of trauma compared to other etiologies.[34] Prompt decompression with a lateral orbital canthotomy and cantholysis can prevent permanent vision loss.

Epidemiology, Risk Factors, and Trends

The United States Eye Injury Registry (USEIR) collects data on ocular trauma, which is then used to identify trends and patterns to establish recommendations for prevention. An extensive review of patients with severe eye injuries with significant functional or structural damage from the USEIR in 1999 revealed age and gender patterns worthy of discussion. Over 50% of injuries occurred in patients under the age of 30 years, with an average overall male-to-female ratio of 4.6:1. Most injuries occurred in the home, followed by the workplace. Of the 20.5% of injuries arising in the workplace, 96% were males, with construction as the leading occupation. Injuries affecting bystanders accounted for 20% of cases.

In this study, corneal injuries were the most common anatomical site of injury found in 52% of patients, followed by retinal injuries in 46%.[35] Injury from blunt objects accounted for 30% of all injuries, followed by sharp objects. Gunshot wounds and motor vehicle trauma were reported as the most frequent causes of bilateral injuries, which accounted for 4% of total injuries.

Only 2% of injuries occurred in patients wearing appropriate safety glasses or goggles, and only 3% were wearing other glasses or sunglasses, suggesting even casual eyewear provides a significant degree of protection.[35]

A retrospective cohort study of Canadian children presenting to the emergency department with eye injuries found a similar gender difference, with boys sustaining injuries 3 times more than girls. It has been hypothesized that risky behavior observed in boys is likely to cause this difference. As in the overall population, injuries in children occur most frequently in the home.[36][37] An increased incidence of injuries during the summer months has also been reported, likely due to the increased time spent outdoors and without direct supervision.

Recent changes and trends in the incidence of ocular injuries have been noted in the literature. Since the 1950s, there has been a decrease in the relative incidence of workplace eye injuries, likely partly attributable to the mandatory use of protective eye devices.[35] In contrast, injuries occurring in the home have increased over time. A recent comparative cohort study found an even further increase in such injuries following stay-at-home orders during the COVID-19 pandemic.[38] 

It was suggested that an increase in self-directed home improvement projects and other hobbies undertaken without appropriate safety regulations or eyewear has contributed to this trend. Overall, workplace injuries continue to decrease as safety protocols are implemented. At the state level, mandatory protective eyewear is becoming more common in adolescent sports and has decreased the incidence of head, face, and ocular injuries.[39][40]

Management & Prognosis

The management of ocular trauma depends on the initial clinical exam with attention to the mechanism of injury. An extensive analysis of USEIR data found that statistical predictors of ocular trauma resulting in final visual acuity less than 20/400 included age older than 60, injury from assault, fall, gunshot, or occurring on a street or highway.[41] After systemic evaluation with verification of hemodynamic and airway stability, timely specialty consultation in such cases should be considered more urgently to expedite the time to intervention. Ultimately, surgery is indicated in many cases. A large epidemiologic study using USEIR data found that 77% of severe injuries required surgery (44% requiring one and 33% requiring more than one surgery).[35]

All first responders and emergency practitioners should be educated in the basics of an ocular exam and the signs and symptoms of vision-threatening, time-sensitive injuries. In these circumstances, ophthalmic consultations should not be delayed. Studies have shown that the final visual prognosis can be improved with rapid examination and, if necessary, surgical repair. In the setting of retrobulbar hematoma, time to treatment is the most important factor in the ultimate visual outcome.[42][43]

Of all ocular trauma, injury to the posterior pole most often results in poorer visual outcomes.[35] Studies have demonstrated that vision impairment secondary to eye trauma can cause long-term personal and societal effects, including decreased quality of life, increased medical costs, and lost productivity.[44] In children, psychosocial consequences cannot be overlooked.

Prevention Strategies & Patient Counseling

The use of protective eyewear can substantially decrease the incidence of ocular injury.[45][46] Patient counseling and education aimed at assessing risk and preventing ocular trauma are essential. Occupational work with chemicals, metal, lasers, UV equipment, and other high-risk exposures requires eye protection, which ideally should be supplied by employers. Workplace-mandated protective eyewear can essentially eliminate the incidence of workplace injuries.[45] 

Broad recommendations and availability of protective eyewear are important now more than ever, especially with an increase in self-directed home improvement projects and a relative increase in the incidence of injuries occurring at home.[38] Eye protection for occupational purposes falls under ANSI/ISEA Z87.1. OSHA publishes specific industry standards. Emergency eyewash stations should be provided in accordance with ANSI/ISEA Z358.1.[47]

Regarding recreational activities, attitudes towards protective eyewear in sports continue to improve.[48][49][50] The American Academy of Pediatrics (AAP) and the American Academy of Ophthalmology (AAO) released protective eyewear guidelines for youth sports participation.[51] 

Protective eyewear should be encouraged in all organized sports, with the prescription of certified equipment as indicated based on sport and fit. The consensus recommends an initial evaluation of all athletes with a discussion of the risks involved in participation and the availability of eye protection. The current standards for eye protection, including ASTM recommendations, are summarized in the following table.

Table

Sport Minimal Eye Protector

Particular attention should be paid to children and adolescents with a history of eye trauma or surgery, as anatomical changes place them at higher risk for severe injury, and to those who are functionally monocular, defined as having a best-corrected visual acuity worse than 20/40 in the poorer-seeing eye. Participants in these categories should undergo evaluation and counseling with an ophthalmologist to further discuss the risk and potential consequences of future injury. High-risk individuals should be counseled to wear polycarbonate lenses full-time to prevent unexpected injuries.

Implementing mandatory eye protection in sports is a growing trend across the United States. Despite increased attention and policy changes, outcome data in ocular injury prevention is slowly being assessed. The use of eye protection in high school lacrosse and field hockey has eliminated the incidence of injury to the orbits, globes, eyebrows, and eyelids. Arguments against increased protective equipment include the risk of more direct contact and aggressive play. While some studies have shown an increased incidence of concussion, others have shown no significant increase in concussion or player-player contact injuries when protective equipment is required.[39][40]

It was suggested that the increase in concussions observed in this study might be the result of increased identification and diagnosis of concussions and not a direct result of rougher play when eye protection is required. 

Activity-Specific Considerations

The AAP/AAO policy statement discusses ocular risk stratification across sports, which can be used to discuss various activities and recommendations for participation in sports activities with patients.[51] The adapted sport-specific safety stratification is displayed in the table below. In sports involving a ball larger than the diameter of the orbit, such as soccer, globe contusion is more likely to occur with both initial findings and delayed complications such as angle recession, retinal tears, and detachments.[52] 

Counseling patients involved in such sports should include the importance of close follow-up and monitoring. Patients should tell all future ophthalmologists about their specific injury so that the clinical exam can be appropriately tailored to identify potential pathology before further complications develop. Boxing carries a high risk of both mild and severe ocular injuries, with a vision-threatening ocular injury prevalence of 58%, according to one study.[53] Additionally, it was shown that the incidence of injuries increases with the time spent boxing. Sports with high-velocity balls, such as golf, have a lower overall incidence of ocular injuries. However, they are more severe and visually significant when injuries do occur.[54]

Table

Ocular Safety in Sports Stratification[51][55] “Safe” Sports

The Monocular and High-Risk Patients

Ophthalmologists have an essential role in diagnosing and managing ocular injuries, prevention, and counseling. The AAP and AAO have specified guidelines surrounding protective measures for functionally monocular children participating in sports.[51] Most ophthalmologists advise against participation in contact sports and strongly recommend against boxing and full-contact martial arts. It is recommended that functionally monocular athletes wear appropriate eyewear for all sports, regardless of inherent risk.

Clinical Significance

Ocular trauma is a leading cause of preventable blindness. Appropriate safety regulations are essential to reduce the occurrence and severity of trauma during recreational and sports activities. Primary and eye care professionals must counsel patients on proper safety precautions and protective eyewear during high-risk activities.[4] Ocular trauma is of significant clinical importance in ophthalmology and eye care. Ocular trauma, or injuries to the eye, can result in severe visual impairment or even permanent blindness. Therefore, it is crucial to educate both patients and healthcare professionals about prevention strategies and appropriate patient counseling to minimize the risk of ocular trauma. Here are some key points regarding the clinical significance of this chapter:[56]

Preventing Vision Loss: Ocular trauma is a leading cause of vision loss worldwide. Patient counseling on prevention strategies can significantly reduce the incidence of eye injuries and their potentially devastating consequences.[57]

Cost-Efficiency: Treating ocular trauma can be expensive, involving surgeries, medications, and long-term follow-up care. Preventing these injuries through education and counseling can save healthcare resources and reduce the financial burden on patients.[58]

Public Health Impact: Ocular trauma affects individuals and has a broader public health impact. Reducing the incidence of eye injuries can improve overall community health and well-being.[59]

Occupational and Recreational Settings: Patient counseling should address specific risk factors in different settings, such as workplaces and recreational activities. For example, workers in industries like construction may face unique risks, and athletes participating in sports may require specialized protective measures.[60]

Pediatric Patients: Ocular trauma prevention is critical in pediatric populations. Children are often unaware of potential dangers and may engage in activities that put them at risk, such as playing with sharp objects or not using proper eye protection during sports.[61]

Older Patients: As people age, their risk of falling and sustaining ocular injuries increases. Patient counseling should address fall prevention strategies, home safety, and the importance of regular eye exams in the older population.[62]

Patient Education: Healthcare professionals should provide clear and accessible information to patients about the risks of ocular trauma and the steps they can take to protect their eyes. This education may include discussing the proper use of safety eyewear, avoiding risky behaviors, and recognizing early signs of eye injury.[4]

Emergency Preparedness: Patients should be informed about what to do in case of an ocular injury, emphasizing the importance of seeking immediate medical attention. Quick action can often distinguish between a full recovery and permanent damage.[58]

Compliance and Follow-Up: The chapter should also address the importance of patient compliance with recommended preventive measures and regular follow-up appointments with eye care professionals.[59]

Collaboration with Other Specialties: Ocular trauma prevention often requires collaboration with other healthcare specialties, such as orthopedics, neurology, and emergency medicine. This chapter should highlight the importance of interdisciplinary care in managing ocular trauma cases.[63]

In summary, the chapter on ocular trauma prevention strategies and patient counseling is clinically significant because it is crucial in reducing the incidence of eye injuries, preventing vision loss, and improving overall eye health. Effective counseling and education can empower patients to take proactive steps to protect their eyes and seek prompt medical attention when needed, ultimately leading to better outcomes and a higher quality of life.[56]

Other Issues

Ocular trauma prevention strategies and patient counseling are essential aspects of eye care. Ocular trauma refers to injuries to the eye or the surrounding structures, and it can result from various causes, such as accidents, sports injuries, workplace incidents, or even daily activities. Here are some key strategies and considerations for preventing ocular trauma and providing patient counseling:[59]

Prevention Strategies: Encourage appropriate eye protection for activities that pose a risk of eye injury. This includes safety glasses, goggles, and face shields when working with tools, chemicals, or machinery or participating in sports like racquetball, hockey, or paintball.[64]

Occupational Safety: Promote workplace safety measures, including using safety glasses or goggles in hazardous work environments. Employers should provide and enforce safety protocols and training for their employees.[65]

Childproofing: Educate parents and caregivers about childproofing their homes to prevent children from accessing dangerous items or areas, such as chemicals, sharp objects, or stairs, that could result in eye injuries.[66]

Sports Safety: Emphasize the importance of wearing protective eyewear during sports and recreational activities with a risk of eye injury. Athletes should choose eyewear designed for their specific sport.[8]

Fireworks and Firearm Safety: Advise against using fireworks at home and educate patients about the potential risks. Likewise, emphasize the importance of proper firearm safety practices, including using appropriate eye protection at shooting ranges.[67]

Ultraviolet Ray Protection: Educate patients about the importance of wearing sunglasses with UV protection to prevent long-term damage from sun exposure. UV radiation can contribute to cataracts and other eye conditions.[68]

Safe Handling of Sharp Objects: Encourage secure handling of sharp objects such as knives, scissors, or needles to prevent accidental eye injuries.[69]

Patient Counseling

Awareness: Raise awareness among patients about the risks of ocular trauma and the importance of prevention. Many people underestimate the potential for eye injuries in everyday life.[70]

Proper First Aid: Educate patients on how to provide immediate first aid for eye injuries, such as rinsing the eye with clean water in the case of chemical exposure or gently covering a penetrating eye injury with a protective shield.[71]

Regular Eye Exams: Stress the importance of regular eye exams to detect any early signs of eye conditions or injuries, especially for patients at a higher risk due to their occupation or lifestyle.[72]

Emergency Contact Information: Ensure that patients know how to reach an eye care professional in an emergency and have access to an eye care first-aid kit.[10]

Adherence to Treatment: If a patient has experienced an eye injury, counsel them on the importance of following the recommended treatment plan and attending follow-up appointments to monitor progress and prevent complications.[73]

Behavioral Changes: Encourage patients to make behavioral changes, such as using protective eyewear, especially if they have previously experienced an eye injury or have a high risk of such injuries.[74]

By implementing these prevention strategies and providing effective patient counseling, healthcare professionals can help reduce the incidence of ocular trauma and promote eye safety among their patients.

Enhancing Healthcare Team Outcomes

Ocular trauma is largely preventable with proper counseling and the use of protective eyewear during high-risk activities.[39][40] Ocular trauma prevention is best performed with a healthcare team. A focused patient assessment and history, including discussion of high-risk activities, are important to guide appropriate counseling and review of ocular trauma prevention strategies.[45][46][35] [Level 3]

High numbers of non-emergent ophthalmology consultations and follow-ups may reflect a lack of comfort among emergency physicians in managing ocular trauma. For this reason, ophthalmologists need to educate and train their colleagues to recognize, triage, and appropriately refer ocular injuries, especially in low-resource settings with limited access to specialty care.

The sequelae of ocular trauma result in various degrees of vision loss with functional deficits that affect all aspects of patient’s lives. It is often up to all healthcare team members, including ophthalmologists, to advocate for patients, ensure access to essential equipment, and educate patients on their rights in the workplace.[75]

Nursing, Allied Health, and Interprofessional Team Interventions

Preventing ocular trauma is crucial for maintaining good eye health and preventing vision loss. Healthcare professionals, including nurses, allied health personnel, and interprofessional teams, play a significant role in educating patients and implementing strategies to prevent ocular trauma. Here are some key prevention strategies and patient counseling tips:

Prevention Strategies

Eye Protection: Encourage appropriate eye protection for high-risk activities, such as wearing safety goggles or helmets with face shields during sports, industrial work, or other potentially hazardous situations.[76]

Education: Provide educational materials and counseling to patients about the importance of eye safety and the risks associated with certain activities or environments.[4]

Childproofing: Advise parents and caregivers to childproof their homes by securing dangerous objects or substances out of a child's reach and ensuring that toys do not have sharp edges or small parts that could cause eye injuries.[77]

Proper Handling of Hazardous Materials: For patients working with hazardous chemicals or materials, emphasize the importance of wearing appropriate eye protection and following safety protocols.[78]

Sports Safety: Educate athletes on the importance of using protective gear, such as sports goggles or helmets, to reduce the risk of eye injuries while playing sports.[8]

Safe Work Environments: For patients in industrial or construction settings, stress the importance of wearing safety glasses or goggles, particularly when working with tools or machinery that can create flying debris.[76] 

Patient Counseling

Risk: Conduct a thorough assessment of the patient's lifestyle, occupation, and recreational activities to identify potential sources of ocular trauma risk.[79]

Eye Safety Habits: Encourage patients to develop and maintain good eye safety habits, such as wearing protective eyewear when needed and avoiding activities that could increase the risk of eye injury.[80]

First Aid Knowledge: Ensure that patients know basic first-aid measures for eye injuries, such as flushing the eye with clean water in case of chemical exposure and avoiding rubbing the eye if a foreign object is lodged.[80]

Regular Eye Exams: Stress the importance of regular eye exams to detect and address any underlying eye conditions that may increase the risk of injury or vision impairment.[81]

Emergency Contact Information: Ensure that patients can access emergency contact information for ophthalmologists or eye specialists in case of a severe eye injury.[82]

Interprofessional Team Interventions

Collaboration: Collaborate with ophthalmologists, optometrists, and other eye care specialists to ensure that patients receive comprehensive eye care and guidance on preventing ocular trauma.[2]

Environmental Assessments: Work with occupational therapists and safety experts to conduct assessments of workplace and home environments to identify potential hazards and implement preventive measures.[83]

Community Outreach: Engage in community outreach programs to educate the public about eye safety and provide access to eye protection resources for those in need.[84]

Research and Policy Advocacy: Advocate for policies and regulations promoting eye safety in various industries and recreational activities and stay updated on the latest research on ocular trauma prevention.[85]

Implementing these prevention strategies, offering patient counseling, and collaborating with other healthcare professionals, nursing, allied health personnel, and interprofessional teams can play a vital role in reducing the incidence of ocular trauma and protecting patients' vision.[86]

Nursing, Allied Health, and Interprofessional Team Monitoring

Preventing ocular trauma is essential for maintaining eye health and preventing vision loss. Nurses, allied health professionals, and interprofessional teams are crucial in educating patients about ocular trauma prevention and monitoring at-risk patients. Here are some strategies and tips for both patient counseling and healthcare team involvement:[64]

Nursing

Patient Education Materials: Develop and distribute patient education materials in various formats, such as brochures, videos, or online resources, to reinforce key safety messages about ocular trauma prevention.[4]

Follow-up Care: Ensure that patients who have experienced eye injuries receive appropriate follow-up care and guidance during their recovery, including wound care, medication administration, and instructions for symptom monitoring.[10]

Medication Management: Educate patients about the proper administration of eye medications, such as eye drops or ointments, and the importance of compliance with prescribed regimens.[87]

Pain Management: Assess and manage pain related to eye injuries and provide patients with pain relief strategies and medications as needed.[88]

Psychosocial Support: Offer psychosocial support to patients who may experience anxiety, depression, or emotional distress following eye injuries and refer them to appropriate mental health professionals when necessary.[89]

Allied Health

Vision Rehabilitation: Allied health professionals, such as occupational therapists and vision therapists, can provide rehabilitation services to patients with permanent vision loss resulting from ocular trauma, helping them adapt to their new visual capabilities.[90]

Low Vision Aids: Evaluate patients for low vision aids and assistive devices that can improve their quality of life and independence after an eye injury.[90]

Occupational Safety Training: Collaborate with occupational health experts to develop and deliver workplace safety training programs tailored to specific industries, addressing eye injury risks and prevention measures.[91]

Interprofessional Team Monitoring

Regular Team Meetings: Hold regular interprofessional team meetings to discuss and review cases of patients at high risk of ocular trauma, ensuring that each team member understands their role in prevention and patient care.[92]

Shared Care Plans: Develop shared care plans that outline the responsibilities of each team member in the prevention, treatment, and rehabilitation of ocular trauma patients, ensuring continuity of care.[2]

Performance Evaluation: Establish criteria to assess the effectiveness of ocular trauma prevention strategies and patient counseling and make necessary adjustments based on outcomes.[4]

Continuing Education: Provide ongoing education and training opportunities for all team members to stay updated on the latest advances in ocular trauma prevention and eye care.[7]

Quality Improvement Initiatives: Implement quality improvement initiatives to track and analyze data related to ocular trauma incidents, identify trends, and implement strategies for further reducing eye injuries.

By incorporating these additional points into nursing, allied health, and interprofessional team monitoring efforts, healthcare professionals can enhance their ability to prevent ocular trauma, provide comprehensive patient care, and continuously improve their practices.[93]

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Disclosure: Marielle Mahan declares no relevant financial relationships with ineligible companies.

Disclosure: Boonkit Purt declares no relevant financial relationships with ineligible companies.