Investigation
The goal of investigation is the assessment of the severity of the ocular injury with an eye to implementing a management plan as soon as is required. The usual eye examination should be attempted, and may require a topical anesthetic in order to be tolerable. Many topical agents cause burning upon instillation. Proxymetacaine has been found to have the best tolerance.
The first step is to assess the external condition of the eye and orbit, and check for perforations, hyphema, uveal prolapse, or globe penetration. If the pupil is teardrop-shaped, and the anterior chamber is flat, this is almost always a perforating injury of the cornea or limbal area.
Depending on the medical history and preliminary examination, the primary care physician should designate the eye injury as a true emergency, urgent or semi-urgent.
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