A 35-year-old man sustains a high-velocity metallic foreign body injury. On examination, there is a small self-sealing corneal entry wound with uveal prolapse visible at the limbus. Seidel's test is positive. The PRIORITY before any other intervention is:
- A Dilate the pupil and perform B-scan ultrasonography
- B Protect the eye with a shield, administer systemic antibiotics (ciprofloxacin + metronidazole), keep nil by mouth, and arrange urgent surgical repair ✓
- C Irrigate the eye and apply a pressure patch
- D Fluorescein staining to map the wound extent
Correct answer: B. Protect the eye with a shield, administer systemic antibiotics (ciprofloxacin + metronidazole), keep nil by mouth, and arrange urgent surgical repair
Explanation
A positive Seidel's test confirms open globe injury. The immediate priorities are: protect the eye with a rigid shield (no pressure on the globe), systemic antibiotics to prevent/treat endophthalmitis, NPO for anaesthesia, urgent surgical repair within 24 hours. Applying a pressure patch risks expelling ocular contents. B-scan is performed with very gentle technique (if at all before surgery). Fluorescein has limited additional value once Seidel's is positive. Pressure on the open globe during examination causes irreversible damage.
Reference: Khurana Comprehensive Ophthalmology, 7th ed.
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Written and medically reviewed by the StethoPrep medical team.