Emergency War Surgery NATO Handbook: Part IV: Regional Wounds and Injuries: Chapter XXIV: Wounds and Injuries of the Eye
United States Department of Defense
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Under battlefield conditions, the casualty with an injured eye is usually seen first by nonspecialized personnel at a facility that has little or no specialized equipment. If his injury is minor, the soldier is treated and sent back to his unit. If it is not, he should be promptly evacuated. The distinction between minor and serious ocular injuries is not always easy to make The most trivialappearing injury may prove to be very serious indeed. If an injury of the eye is properly managed, a good result (or at least some salvage of vision) is often secured even in serious injuries. If improperly managed, a trivial penetrating ocular wound may be converted into a serious one; a large majority of these may result in blindness. All care providers must know how to detect, assess, and initially manage patients with eye injuries. The mandatory principles of initial management are presented in this chapter. In ophthalmic surgery, the first opportunity to repair an injury is usually the only opportunity. There is an inordinately high rate of ocular injury relative to the amount of surface area exposed to injury. Although comprising as little as 0.10% of total body surface and only 0.27% of the erect frontal silhouette, the eye is injured in nearly 10% of nonfatal casualties. The likelihood of ocular injury is further increased by various postures assumed in warfare. For example, although 25% of the projected body surface is exposed in the prone position, the eye comprises a considerable proportion of the prone silhouette. The recent introduction of laser technology to the battlefield will lead to a new class of ocular injury. These injuries are most likely to fall into two categories. The first category is that of thermal burns of the eyelids and cornea. The second category constitutes injury to the retina and vitreous body, leading to intraocular hemorrhage. Laser injuries of the eye are covered separately.
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