Eye shields are used to protect the eye from further injury when the integrity of the globe is compromised or potentially compromised.1 The best results are obtained when early repair of globe disruption occurs and before any globe contents leak out or change position.2,3 Eye patches are intended to prevent movement of the eyelid over an injured but intact cornea.1,4,5 Eye patching has historically been used to protect the eye from bright light, to facilitate healing of a corneal abrasion, or to protect the cornea from injury during sleep. There have been no substantial changes in the indications for eye shields and their method of application.6-9 Eye patching has become increasingly controversial.6-10
Eye shields serve as temporary protection for patients in whom a penetrated or ruptured globe is suspected.11-13 The purpose is to prevent further injury as extravasation of globe contents is associated with poor vision outcomes.3,14 A ruptured globe is a vision-threatening emergency. 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.12,13,15-17 Globe rupture should also be suspected from penetrating corneal wounds from foreign bodies (e.g., tiny pieces of metal).18,19 Further eye examination or eye manipulation is contraindicated if a ruptured globe is suspected. Do not measure intraocular pressure. It can worsen or cause the extrusion of globe contents.20 An eye shield is applied immediately and to remain in place while other injuries are managed, tests are obtained (e.g., orbital computed tomography [CT] scans), and the consulting Ophthalmologist is contacted.3,13
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 eye shield relies on its edges being supported by the orbital rim, frontal bone, and maxillary bone.
Most Emergency Departments stock commercially available eye shields. A clean, disposable paper drinking cup may be used if an eye shield is not available.5,21 Use a scissors to make 3/4 to 1 inch deep cuts around the open end of the cup (Figure 193-1). 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.