Occult intraocular trauma: evaluation of the eye in an austere environment

J Emerg Med. 2013 Mar;44(3):e295-8. doi: 10.1016/j.jemermed.2012.09.028. Epub 2012 Dec 8.


Background: Physicians deployed to austere environments often encounter the challenge of needing to make clinical decisions based upon rudimentary history and physical examination. These skills, however, can be difficult for many to rely on, with the many subtleties of examining the eye, when they are normally accustomed to relying on sophisticated modalities to establish diagnosis.

Objectives: This case is a model for evaluating eye trauma in an austere or hostile environment.

Case report: A 25-year-old male U.S. Marine was fired upon at a Mexican Army checkpoint where he sustained glass shrapnel injuries, the most serious being to his right eye. He was taken from a detention facility to a Mexican hospital, where he was evaluated and given the diagnosis of corneal laceration. Twelve hours later, a U.S. Navy physician arrived to evaluate the patient; he was allowed limited access to the patient. His ophthalmologic examination revealed a closed corneal laceration on the right eye, worse than 20/800 vision, absent red reflex, and obscured funduscopic examination. These findings made it impossible to rule out globe penetration. The patient was released 48 h later to a U.S. Naval Hospital, where intraocular foreign bodies were confirmed by imaging and he was taken to emergency surgery.

Conclusion: This case illustrates that even under austere conditions, a focused history and evaluation can reveal the likelihood of occult intraocular foreign body, thereby triaging the patient for emergency surgery.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Eye Foreign Bodies / complications
  • Eye Foreign Bodies / diagnosis*
  • Eye Foreign Bodies / diagnostic imaging
  • Humans
  • Male
  • Military Personnel*
  • Patient Transfer
  • Tomography, X-Ray Computed
  • United States
  • Vision Disorders / etiology