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Check the pH of the tear film using litmus paper two to three minutes after each bag of fluid and repeat until the pH measures 7 – 8 and appears equal between the two eyes.Patients with an injury which has penetrated the eye should be referred immediately for an ophthalmological assessment.Tetanus status should be determined, a hard shield taped over the eye (without exerting pressure on the globe), and the patient instructed not to eat or drink in preparation for possible surgery. A penetrating injury may be obvious in the case of a grossly misshapen globe or a full-thickness corneal or scleral laceration with prolapse of intraocular contents. However, subtle clues to look for include a shallowing of the anterior chamber in that eye, or tear-drop distortion of the pupil due to the iris prolapsing through an unnoticed wound, although these features may be difficult to detect without the use of a slit lamp. Patients with an injury caused by a high-velocity object, e.g. when striking metal on metal, or a sharp object, e.g. glass, thorn, knife, should be treated as having a high suspicion of penetrating injury, even if no foreign object is visible.5Management of acute angle closure glaucomaThis is a medical emergency and the patient should be discussed with an Ophthalmologist immediately to determine initial management and arrange urgent assessment.Symptoms of raised intraocular pressure are deep eye pain (described as throbbing, drilling pain), redness, blurred vision (often with haloes around lights due to corneal oedema), headache, nausea and vomiting. Suggestive signs are ciliary injection, fixed mid-dilated pupil, a generally hazy cornea and decreased visual acuity (Figure 3).Photo kindly supplied by Dr Logan Mitchell, Department ofAlthough most General Practitioners will not have access to a tonometer (to measure the intraocular pressure), digitally palpating the globe behind closed eyelids and comparing globe firmness provides useful information. In some circumstances and locations an urgent intraocular pressure measurement by a local Optometrist may be indicated. While waiting, the patient should lie flat with their face up, without a pillow.
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