EYE DISORDERS - Medicine for Mountaineering and Other Wilderness Activities - page 199

Most corneal ulcers are infected and require some form of antibiotic treatment. The
cause of the infection is most commonly a herpes virus, bacteria, or fungi. In a clinic or
hospital, cultures are taken prior to treatment to identify the infective agent and the antibi-
otic to which it is sensitive. In an outdoor environment, culture is unfeasible. Therefore, if
a corneal ulcer is suspected, antibiotic treatment should be initiated and the person should
be evacuated to the nearest hospital or clinic for proper diagnosis and care.
TRAUMA
In outdoor settings the eye can be traumatized in a number of ways. These can range
from nuisances to emergencies and can cause a wide range of symptoms, including visual
changes, pain, swelling, hemorrhage, tearing, and discharge.
Lid Lacerations
Lid lacerations can happen in a variety of ways. Projectile foreign bodies, falls, tools,
orfishhooksare notuncommon causes. Ahealthy eyelid isabsolutely necessary toprotect
the eye and keep it functioning properly. Therefore, lid lacerations should be considered
serious. First and foremost, bleeding must be stopped and further damage must be preven-
ted, which can usually be accomplished with a pressure bandage. The lid should be closed
as much as possible, the margins of the laceration should be approximated as closely as
possible and a bandage placed over it and secured in place. The individual should be evac-
uated to the nearest medical facility as soon as possible.
Globe Injuries
Globe (eyeball) injuries often result from penetrating foreign bodies or blunt trauma. In
an outdoor setting, this may take many forms including rocks, tree branches, or fish hooks.
Globe injuries can result in severe traumatic damage to any part of the eye or in infec-
tion. Hemorrhages may infiltrate the retina, resulting in retinal detachment, or may infilt-
ratethefluidthatfillstheeye.Thelensmaybedamagedordislocated,resultingeventually
in a cataract. The drainage system of the eye may be damaged, leading to increased risk of
glaucoma. Finally, trauma may result in rupture of the globe or an orbital blowout fracture,
in which the eye is forced through the inferior floor.
As with lid lacerations, bleeding should be stopped and further injury should be preven-
ted. Only superficial foreign bodies should be removed. Trying to remove embedded for-
eign bodies may cause more damage or result in more bleeding. Antibiotics should be ap-
plied, and a covering bandage should be secured over the eye. The person should be evac-
uated immediately to the nearest medical facility.
Globe Rupture