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Eye shields are used to protect the eye from further injury when the integrity of the globe is compromised or potentially compromised. The best results are obtained when early repair of globe disruption occurs, before any contents leak out or change position.1,2 In contrast, eye patches are intended to prevent movement of the eyelid over an injured but intact cornea.3,4 In the past, eye patching was performed to protect the eye from bright light, facilitate healing of a corneal abrasion, or protect the cornea from injury during sleep. While there have been no substantial changes in the indications for eye shields and their method of application, eye patching has become increasingly controversial.58

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Indications

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Eye shields serve as temporary protection for patients in whom a penetrated or ruptured globe is suspected.9,10 The purpose is to prevent further injury, with resultant extravasation of the contents of the globe and resultant outcome of poor vision.2,11 The signs associated with a ruptured globe include bloody chemosis, increase or decrease in the depth of the anterior chamber, irregular or peaked iris, positive Seidel test, vitreous hemorrhage, low intraocular pressure, hyphema, and loss of visual acuity.9,10,1214 If a ruptured globe is suspected, further examination is contraindicated. Instead, an eye shield is applied immediately and remains in place while other injuries are managed, tests are obtained (e.g., orbital computed tomography scans), and the consulting Ophthalmologist is contacted.2,10

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Contraindications

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The only contraindication to the application of an eye shield arises when the surrounding face and orbits are so extensively damaged that the metal shield or its edges will directly injure the globe. The protective function of the shield relies on its edges being supported by the orbital rim, frontal bone, and maxillary bone.

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Equipment

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  • Metal or plastic eye shield
  • 1 inch tape

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If commercially available eye shields are not available, a clean, disposable paper drinking cup may be used.4,15 Use a scissors to make 3/4 to 1 inch deep cuts around the open end of the cup (Figure 161-1). Make approximately six to eight cuts around the circumference of the cup. Fold the flaps on the open end of the cup outward. Styrofoam cups are not suitable because the flaps can easily break off and cause further injury to the globe.

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Figure 161-1.
Graphic Jump Location

A paper cup may be used if a commercial eye shield is not available. The top of the cup is cut in multiple places and the resulting “flaps” are bent down to create a flat surface.

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Patient Preparation

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The first procedure in patients with a suspected ...

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