Medicine for the Outdoors
Medicine for the Outdoors

Dr. Paul Auerbach is the world's leading outdoor health expert. His blog offers tips on outdoor safety and advice on how to handle wilderness emergencies.

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A Close Call

Kids will be kids, no matter how much you warn them about potential catastrophes. One came close recently, despite my admonition to be smart and keep his head down. The young man needed to travel a short distance over a remote road and wanted to ride standing in the bed of a pickup truck. The speed was going to be well under 5 miles per hour and there was no chance of a collision, but I was worried about low-hanging branches, a bad pothole or tree root in the pathway, or some other unforeseen hazard. Despite my caution, the boy's father said it was OK for him to ride in the back, which would have been all right 999 times out of 1000.

Except for this time. The poor boy looked away from the direction of travel for a brief moment, and when he turned around to face forward, caught a tree limb across his forehead. He immediately felt severe pain in his eye, and began to shout in distress. It was obvious that he had been struck in the eyeball. When I saw him a few moments later, he was miserable and crying crocodile tears.

I was able to quickly determine that he didn't have a ruptured "globe" (eyeball), and he was begging for relief, so I put a few drops of ophthalmic anesthetic solution into his eye, which made the pain go away quickly. After I pulled his lids back, I was able to achieve fairly good visualization of the surface of his eye. There was one small fleck of tree bark under his upper lid, but otherwise, his eye was free of foreign material. While the surface of his eye remained numb from the anesthetic, I rinsed it carefully with some disinfected water. He was a lucky fellow, because all he had done was to suffer a few small scratches on the white of his eye. If he had not had the great reflexes of youth and been able to duck a bit prior to impact, he easily could have sustained a much worse injury.

What if that had happened? If an eyeball is perforated, there will be a combination of loss of vision (ranging from hazy vision to blindness), pain, excessive tearing, a dilated pupil, and visible blood in the eye. If that is the case, do not attempt to rinse out the wound vigorously; remove obvious dirt and debris without placing any pressure on the eye. Close the eyelid gently and cover the eye with a protective shield. This can be fashioned by cutting gauze pads or soft cloth to the proper size, or by fashioning a doughnut-shaped shield with a cloth, cravat bandage, or shirt. Another good way to keep pressure off the eye is to cut an eye-sized hole in a stack of gauze pads and place the stack over the eye, taping or wrapping it in place. An eye shield can also be improvised by cutting off the bottom 2 in (5 cm) of a paper cup and taping it over the eye. Metal or plastic pre-shaped eye shields can be carried.

Do not exert pressure on the eyeball, because this can increase the damage. Instruct the victim to keep both eyes closed, and start him on oral ciprofloxacin, penicillin, cephalexin, or erythromycin. Seek immediate medical attention.

If the surface of the eye is merely scratched (abraded), then a corneal (clear part of the eye) or conjunctival (membrane over the white part of the eye) abrasion may have occurred. This will be painful because exposure of sensitive nerves to air is sufficient to provoke a significant pain response. If a corneal abrasion is felt to have occurred, the eye can be treated with topical antibiotic solution and the victim provided with sunglasses if the eye(s) has become sensitive to light. It is no longer deemed absolutely necessary to put a patch over an eye that has suffered a corneal abrasion. However, if the pain is relieved significantly by having the eye closed, this can be accomplished by gently taping a patch over the closed eye or by keeping the lids shut with a piece of tape gently applied over the lids. After 24 hours, the patch or tape should be removed to be certain that there is no underlying infection (which should not be patched) and to see if sufficient healing has occurred to allow the victim to tolerate an unpatched eye.

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About the Author

Dr. Paul S. Auerbach is the world’s leading authority on wilderness medicine.