A 28-year-old carpenter presents with a hammering injury to the right eye from a nail. There is a visible full-thickness corneal laceration with iris prolapse. Vision is hand movements. While arranging emergency surgery, what is the single most important immediate step in the emergency department?

• A Apply a rigid Fox shield without any pressure on the globe ✓
• B Gently reposition the prolapsed iris tissue back into the anterior chamber
• C Irrigate the eye with normal saline to remove debris
• D Instill topical antibiotic drops and apply a tight pressure bandage

Explanation

Applying a rigid eye shield (Fox shield) without any pressure on the globe is the most critical immediate step. It protects the eye from accidental further pressure that could extrude intraocular contents through the open wound. Repositioning prolapsed tissue in the emergency room is not done; it is managed in the operating theatre. Irrigation and pressure bandages are contraindicated. Topical drops may be used but are secondary to shielding.

Reference: Kanski's Clinical Ophthalmology, 9th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.