Chapter 6: Classification of ocular trauma and principles of first aid Chapter 1: Overview For both clinical and scientific research, a strict and standard classification of ocular trauma not only unifies the understanding and academic language, but also facilitates the evaluation of the results of multicenter management of ocular trauma and the selection of the optimal treatment plan, thus making the research and treatment of ocular trauma more systematic, scientific and effective, and the prognosis more accurate. This will make the research and treatment of ocular trauma more systematic, scientific, effective, and accurate in determining the prognosis. There are various classifications of ocular trauma, which can be divided into mechanical and non-mechanical injuries according to the cause, and the former can be divided into open and closed categories; the latter can be chemical burns, thermal burns, laser injuries, radiation injuries, physical injuries, electric shock injuries, gas injuries, etc. According to the injury situation, it can be divided into minor, moderate and serious injuries. According to the emergency classification, there are primary emergency, secondary emergency, and tertiary emergency. In addition, injuries can be classified according to the site of injury, such as eyelid, orbit, eye muscle, conjunctiva, lacrimal apparatus, cornea, sclera, iris, lens, retina, optic nerve, etc. The characteristics of ocular trauma vary greatly from one classification to another, while the same classification has many common features. By summarizing the clinical characteristics of various ocular trauma and multicenter treatment experience, we can summarize the unified principles of emergency care, so that we can have rules to follow when facing various complex ocular trauma, and thus take the most mature and effective treatment measures to improve the success rate of treatment. With the development of modern industry, the incidence of ocular trauma is higher, more diverse, and more complex than in the past, and the severity of various ocular trauma is not exactly the same, so there is naturally a priority in treatment. The emergency and critical ocular trauma can be treated in a timely and effective manner. A, eye trauma injury classification according to the degree of trauma and the impact on the prognosis, generally according to the injury is divided into light, medium and heavy three levels. (a) minor injuries simple eyelid, conjunctival injuries, superficial corneal foreign body and abrasions, eyelid I degree burns, irritating gas injuries, snow blindness, electrophotographic ophthalmia, atomic bomb blast after a transient blindness, etc.. (ii) Moderate injuries: heavy lacerations of the eyelid and conjunctiva, extraocular muscle injuries, lacrimal lacerations, second-degree burns of the eyelid, multiple foreign bodies of the cornea and superficial foreign bodies of the corneal parenchyma, unilateral bleeding of the anterior chamber of the eye not exceeding the pupil, clouding of the lens but with the capsule intact and without serious visual impairment, retinal shock injuries, bilateral visual impairment without obvious fundus lesions, etc. (C) Serious injuries Large complex lacerations of the eyelid, penetrating eye injuries in various areas, orbital bone fractures, deep corneal foreign bodies, intraocular and retrobulbar foreign body deposits, impact ocular trauma (vision loss, intraocular hemorrhage, anterior chamber hemorrhage exceeding the pupil, vitreous hemorrhage, retinal hemorrhage, etc.), ballistic eye injuries, crush injuries of the eye, severe visual impairment or blindness of both eyes, thermal burns of the eye, chemical burns, military toxic agent injuries light radiation injury, etc. Second, the emergency classification of ocular trauma different ocular trauma, treatment time has a great impact on the prognosis, so according to clinical experience can be divided into three levels of ocular trauma according to the emergency. This classification is entirely according to the condition of ocular trauma, but in clinical practice, ocular trauma is often combined with other parts of the body, especially head and facial trauma, therefore, before dealing with ocular trauma, life-threatening trauma should be dealt with first, and then deal with ocular trauma after the danger period. In the case of head, face and body trauma, general anesthesia can be used to treat ocular trauma as soon as possible. (a) First-level emergency care is the most urgent category. In treatment, we must race against time to save the patient immediately, otherwise the condition will be irreversibly aggravated. After the arrival of the injured, according to the patient’s complaints or other people’s complaints and rough examination results, the initial grasp of the condition immediately after treatment. 1.Corneal chemical burns, thermal burns, military gas injuries; 2.Occlusion of the central retinal artery. (2) Secondary emergency care is a more urgent category. The condition is more serious and must be treated within one to several hours. These injuries are relatively complex, and in order to make a clear diagnosis, the physician must take a careful history, perform the necessary tests, and develop a practical treatment plan. Some treatments may be simpler and shorter, while others may be very complex, requiring staged treatment and taking longer. 1, ocular laceration or rupture injury; 2, ocular explosion injury; 3, perforation injury or intraocular foreign body injury; 4, ocular contusion, including anterior chamber hemorrhage, lens dislocation or dislocation into the subconjunctival capsule, retinal concussion, vitreous hemorrhage, etc.; 5, ocular crush injury; 6, corneal foreign body or abrasion; 7, eyelid laceration; 8, acute vision loss following craniocerebral trauma; 9, acute light radiation injury such as electrophthalmia, Snow blindness, eclipse ophthalmia. (c) Tertiary emergency care is a general emergency. The condition is relatively simple, the early or late treatment does not have a large impact on the prognosis, and can be easily examined and treated. 1. subconjunctival hemorrhage; 2. intraorbital hematoma; 3. blast fracture of orbital floor; 4. retinal detachment with the fissure located above the temporal area; 5. acute optic papillitis and retrobulbar optic neuritis. Section 3: Classification of mechanical ocular trauma In ocular trauma, mechanical ocular trauma accounts for the vast majority of trauma, therefore, a systematic and standardized classification of mechanical ocular trauma is of great significance to guide our clinical and scientific research, yet a strict and standard classification of mechanical ocular trauma has been lacking in the past, and there is a lack of uniform expressions for the same trauma, and some of them are even semantically ambiguous and ambiguous. For example, in the general medical dictionary, a laceration is defined as a “torn, torn, bloody wound”, while a simple sharp cut is ignored and therefore cannot be distinguished from other types of wounds; sometimes the same condition has different terms, for example, a trauma with both an entrance and an exit is called a double penetrating wound, a penetrating wound Sometimes the same terminology is used to describe completely different conditions, for example, a trauma with both an entrance and an exit is called a double penetrating injury, a penetrating injury, a double penetrating injury, and a double penetrating injury. For this reason, in 1996, ophthalmologists from the United Kingdom, the United States, Germany, and Israel revisited the ambiguous ocular trauma terminology that had been used in ophthalmology for the past 100 years and redefined the terminology of mechanical ocular trauma with reference to the standard terminology of systemic medicine (see Table 1). The new classification uses the eye as the frame of reference, and open versus closed and penetrating versus penetrating are specific to the eye, not to the damaged tissue. The classification system provides a clear definition of each term and a comprehensive classification of injury types (e.g., Table II). The classification is endorsed and recognized by the International Society for Ocular Trauma, the American Registry of Ocular Trauma, the American Academy of Ophthalmology, and the Hungarian Registry of Ocular Trauma, the Vitreous Society, the Retina Society, and the Ocular Trauma Society. It should also be noted that this classification system is limited to mechanical ocular trauma and does not apply to chemical, thermal and electrical injuries. Table I: Terms and definitions of mechanical ocular trauma *Terms Definitions Remarks The eyewall (eyewall) The sclera and cornea Anatomically, the eyewall is divided into 3 layers, here only the hard sclera and cornea Closed ocular injuries The eyewall does not have a full-length wound Injuries caused by sharp forces to part of the thickness of the eyewall, such as closed-globeinjuries, contusions caused by blunt force and Open-globe injuries with superficial foreign body retention Open-globe wounds in the eye wall Injuries to the entire corneal sclera (open-globeinjuries) Rupture injuries to the entire wall of the eye caused by blunt force Rupture of the wall of the eye from its weakest point, either at or (rupture) injury, sudden increase in intraocular pressure at the moment of blunt force impact Rupture of the wall of the eye from the inside out mechanism of injury not at the point of force A single wound of the entire wall of the eye, caused by a sharp object without an outlet (penetratinginjuries), is in principle a perforation injury, due to the clinical significance (intraocularforeignbody). Because of the different clinical significance (treatment, prognosis) of intraocularforeignbodyinjuries, they are classified separately as penetrating injuries Two full-layer wounds of the eye wall (entrance and exit must be caused by the same object (perforatinginjuries)) are often contusions caused by taxing, high-speed flying objects Closed eye injuries are often caused by blunt force, contusion without a full wall wound (contusion) or secondary to eye deformation and instantaneous pressure transfer phase injury can occur in lamellar laceration to more distant sites wall and conjunctival injuries occur in partial laceration of the conjunctiva and wall (lamellarlaceration) impact site, often caused by sharp objects superficial foreign body injury closed eye injury, caused by The injury can be caused by sharp force, blunt force, or a combination of both, causing injury to the entire wall of the globe Note: This table is translated from Ophthalmology 1 996,1 0 3 :2 40 – 2 43 Table II Classification of ocular trauma tree rupture injuries ocular trauma Closed ocular trauma open ocular trauma contusion laminar laceration laceration penetrating injury intraocular foreign body In 1997, 1 3 ophthalmologists from 7 ophthalmic institutes in the United States , in addition to the original classification system was refined, proposed the classification of ocular trauma, grading and injury discrimination system, thus making the classification of ocular trauma more clinically instructive. I. Classification, grading and injury discrimination of open eye injury 1, injury type: there are five types of injuries: rupture injury, perforation injury, intraocular foreign body, penetration injury and mixed injury. 2, injury classification: based on the visual acuity of the initial examination after the injury. Snellen distance visual acuity table or Rosen baum near visual acuity table, can also record the best visual acuity wearing corrective lenses or pinhole lenses. 1 grade ≥ 20/40 (≥ 0 .5); 2 grade 2 0/50 ~ 20/100 (0 .4 ~ 0 .2 ); 3 grade 1 9/1 0 0 ~ 5/2 0 0 (0 .1 9 ~ 0 .0 2 5); 4 grade 4/200 ~ light perception (0 .0 2 ~ light perception ); 3 grade 1 9/1 0 0 ~ 5/2 0 0 (0 .1 9 ~ 0 .0 2 5); 4 grade 4/200 ~ light perception (0 .0 2 ~ light perception ); 4 grade 4/200 ~ light perception (0 .0 2 ~ light perception ); 4 grade 4/200 ~ light perception (0 .0 2 ~ light perception ); 4 grade 4/200 ~ light perception 0 2 ~ light sensation ); 5 level no light sensation. 3, pupil: the presence of relative pupillary conduction disorder is used to initially determine the function of the retina and optic nerve of the injured eye. Positive refers to the presence of conduction disorders, negative refers to the absence of conduction disorders, examination with flickering light. 4, injury zoning: Zone I injury only in the cornea and corneoscleral rim, Zone II injury involving the sclera before 5 mm range, Zone III injury more than 5 mm after the corneoscleral rim. open eye injury with multiple mouths according to the last wound zoning, intraocular foreign body according to the entrance zoning, penetrating injury according to the exit zoning. Injury zoning is often done after surgery to make certain corrections. Second, the closed eye injury classification, grading and injury discrimination because of the relationship between injury and prognosis of closed eye injury research is not much, the classification of closed eye injury basically refer to open eye injury. Closed eye injury types include: contusion, laminar laceration, superficial foreign body injury, and mixed injury. Grading: According to the visual acuity grading, the method is the same as open injury. Pupil: the same as the open eye injury. Zoning: Zone I: external, the surface layer of the bulbar conjunctiva, cornea and sclera; Zone II: anterior segment, from the corneal endothelium to the posterior capsule of the lens, including the ciliary process, excluding the flat part of the ciliary body; Zone III: posterior segment, the internal structure from the posterior capsule of the lens onwards. Classification of closed eye injuries is based on the pathology of the injury , and zoning is based on the anatomic location of the eye injury , not the wound. Zone I commonly involves corneal abrasions, traumatic subconjunctival hemorrhage, and interlaminar foreign bodies. Zone II mainly involves anterior segment and anterior chamber hemorrhage, pupillary dilatation , crystal clouding, and suspensory ligament dissection. Zone III mainly involves posterior segment injury, including ciliary flatus, choroid, retina, vitreous and optic nerve. When the injury involves more than one area, the posterior location is partitioned, and the refractive interstitial clouding affects the posterior view with the aid of ultrasound. Section IV: Classification of chemical burns of the eye Chemical burns of the eye is a first-class ophthalmic emergency, the treatment of which is a race against time, so only with a clear understanding of the different types of chemical burns, treatment measures can be more clear and effective. Based on the pH value of the chemical substance, the chemical substance damage to the eye tissue can be divided into three categories: neutral, acidic and alkaline. They have different mechanisms of injury and produce different clinicopathological results. Acids or bases can be subdivided into strong acids, strong bases and weak acids and bases. Acid is a water-soluble liquid, while the corneal epithelium and conjunctiva of the human eye are fat-soluble, so weak acids do not penetrate strongly into the tissues, and hydrogen ions produce precipitation upon contact with proteins, providing some protection for the corneal stroma and intraocular tissues, and protein precipitation of the epithelium can make the surface of the cornea form a hairy glass-like appearance, giving the illusion of serious damage, which can be restored to transparency once the epithelium is replaced. Strong acids can easily pass through the coagulation layer formed with the corneal epithelium or conjunctiva and enter the water-soluble corneal stroma and sclera, thus deepening the damage. Alkalis are both water-soluble and fat-soluble fluids that dissolve fats and proteins and can quickly penetrate into the deeper layers and the eye upon contact with tissues, causing extensive damage and serious damage to the eye. The stronger the alkali, the more severe the damage caused. In addition, the penetration of alkali or strong acid can easily cause blood vessel thrombosis within the cornea, conjunctiva, sclera and uvea, and in the most severe cases the eye tissue damage is difficult to repair and can cause ocular consumption. Clinically, according to the tissue reaction after acid-base burns, it can be divided into three degrees: mild, moderate and severe. Mild: mostly caused by weak acids or dilute weak bases, manifested as eyelid and conjunctiva congestion and edema, corneal epithelial punctate detachment or edema. Moderate: caused by strong acids or dilute alkalis, the lid skin may blister or erode, the conjunctiva is edematous with small patches of ischemic necrosis, the cornea is obviously edematous and cloudy, and the epithelium is completely detached or forms a white solidified layer. After healing, a small amount of conjunctival scarring or corneal opacity remains, affecting vision; severe: mostly caused by strong alkali, the conjunctiva shows extensive ischemic necrosis and is grayish white. The entire cornea is grayish or porcelain white. The necrotic tissue releases chemokines, causing neutrophil infiltration and release of collagenase, dissolution of the corneal stroma, and corneal ulceration or perforation. Alkali may also penetrate into the anterior chamber, causing uveitis and secondary glaucoma or cataract. Corneal ulcers heal to form corneal leukoplakia, while corneal perforations form anterior adhesive corneal leukoplakia, corneal chylomegaly and even ocular atrophy. Conjunctival necrosis heals to form massive scarring, causing lid adhesions. Eventually, the eye function is severely impaired or the eye is lost. Ocular injuries caused by neutral substances are mainly caused by the harmful components of the substance. There are many types of neutral substances and the damage caused to the eye has its own characteristics, for example, ethanol, butanol, cyanide, heavy metals, organic pesticides, etc. The mechanism and severity of the damage caused to the eye are different, and it is impossible to have a uniform clinical diagnosis and treatment standard, so it is difficult to classify them. Fifth Other types of ocular trauma I. Ocular thermal burns Ocular thermal burns are ocular injuries caused by high temperature gases, liquids or solids. Therefore, according to the nature of the causative agent can be divided into hot flame burns, hot gas burns, hot liquid burns and high temperature object burns. According to the damaged area, they can be divided into eyelid burns, conjunctival and scleral burns, and corneal burns. According to whether there is direct contact between the injury-causing object and the eye, it can be divided into contact burns and non-contact burns. Contact burns are burns caused by direct contact of high temperature liquids or solids with the eye, while non-contact burns are mainly burns caused by high temperature gases, hot flames or close thermal radiation. The degree of damage from contact burns is related to the size of the contact (or the amount of liquid), the contact time and the temperature of the substance. Non-contact burns, on the other hand, are primarily related to the temperature and duration of the eye exposure environment. The grading of burns: The grading standards for ocular burns (including chemical and thermal burns) adopted by the National Eye Trauma and Occupational Eye Disease Collaborative Group in 1982, combined with the skin burn classification method, can be divided into four degrees of ocular burns (the following table): Calculation of the area of burns: the area of burns less than 1/4 is “+”; 1/4~1/2 is “++”; greater than 1/2 and less than 3/4 is “+++”; greater than 3/4 is “++++”. The conjunctival area calculation was based on the bulbar conjunctiva. Ocular burns grading scale grading eyelid conjunctiva cornea cornea rim Ⅰ congestion mild congestion edema epithelial damage without ischemia Ⅱ blister anemia parenchymal superficial edema, iris texture visible ischemia ≤ 1/4 Ⅲ skin necrosis whole layer necrosis, capillaries not visible parenchymal superficial edema, turbidity is obvious, iris vaguely visible 1/41/2 II, eye frostbite frostbite is caused by cold-induced primary tissue freezing and secondary blood circulation disorders. It is caused by cold. The diagnosis of frostbite is mainly based on clinical manifestations and history of freezing, and it is difficult to determine the degree of damage to tissues that are still in a frozen state, so the degree of frostbite can only be determined after thawing. Because of the rich blood circulation in the eye, the chance of ocular frostbite is less, but in exceptional cases, eyelid or corneal frostbite can occur. Third, radiation eye injury radiation injury includes ionizing radiation injury and non-ionizing radiation injury. Ionizing radiation injuries include far ultraviolet (short wavelength), X-rays, γ-rays and nuclear radiation caused by the injury. These rays are more and more energetic as the wavelength decreases. They are radiated by neutrons, atoms, neutrons, protons and other particles in a changed state of motion, which can penetrate into different depths of tissues and produce biological effects in the tissues, a kind of high-energy photon effect. Non-ionizing radiation injuries include injuries caused by near ultraviolet light, visible light, infrared light, microwaves, etc. These electromagnetic waves are emitted by electric oscillators, etc., with longer wavelengths and weaker energy, producing photochemical or thermal effects within the tissue. 1, infrared damage Infrared light is usually generated by high-temperature objects, the damage to the eye is mainly thermal effects, which is due to the infrared vibration propagation energy is absorbed by the tissue, so that the molecular movement rate in the tissue increases, the temperature rises. Infrared damage to the eye commonly caused by: chronic blepharitis, thermal cataracts caused by long-term exposure to low-energy short-wave infrared environment (such as blast furnace and glass workers), observation of solar eclipse and caused by eclipse retinal burns. 2, ultraviolet damage Ultraviolet is part of the radiation, there are long-wave ultraviolet (300 ~ 400nm) and short-wave (180 ~ 300nm) two. Wavelength 315 ~ 400 nm, the effect on the tissue is slight; wavelength 280 ~ 315 nm, the skin has a strong effect; wavelength 200 ~ 280 nm, the tissue protein and lipid destruction, and cause hemolysis; wavelength 250 ~ 320 nm of ultraviolet radiation can cause electro-optical ophthalmia, especially wavelength 265 ~ 280 nm is the most serious; wavelength 375 ~ 400 nm Wavelength 375-400 nm, a very small part can invade the fundus of the eye; wavelength 300-375 nm, can reach the lens; wavelength 300 nm or less short-wave ultraviolet radiation, the depth of invasion does not exceed the cornea. Depending on the wavelength of ultraviolet light, it can cause electro-optic uveitis (snow blindness), cataract and retinal damage in the fundus respectively. Welding, plateau, snow and water reflections, ultraviolet lamps and atomic bomb explosions and other emissions are generally short-wave ultraviolet, wavelength of about 290nm, can cause ocular ultraviolet damage that electro-optic uveitis. Generally after 3-8 hours of exposure, there is a strong foreign body sensation, stinging pain, photophobia, lacrimation and blepharospasm, conjunctival mixed congestion, corneal epithelial peeling. 24 hours later, the symptoms begin to reduce. 3.Injuries caused by X-rays, γ-rays and nuclear radiation These are all ionizing radiation and can cause damage to all kinds of eye tissues, including the conjunctiva, cornea, lens, uvea, retina and optic nerve, the sclera is less sensitive. Ionizing radiation injuries are generally caused by external exposure to tumors, but can also be caused by nuclear leakage or nuclear contamination. The mechanism of action of ionizing radiation injury is generally considered to be three: one is the direct action of radiation on tissue cells, causing abnormal cell growth or death; the second is to cause tissue vascular damage, and then cause secondary damage; the third is a large number of cell disintegration products into the blood, triggering systemic toxic reactions, namely, radioactive shock. 4, laser damage Laser (Laser) is the abbreviation of the stimulated emission of light. Laser has strong directional, high brightness, monochromatic and good coherence and other characteristics. There are many types of lasers, including gas, solid, semiconductor, chemical and liquid lasers according to their working substances. According to the mode of emission is divided into continuous and pulsed lasers. Commonly used lasers oscillate at wavelengths starting from 0.2um ultraviolet, including visible light and infrared. Since the refractive medium of the eye and the retina transmit and absorb light differently, different wavelengths of lasers cause different sites of damage to the eye. Generally speaking, UV and far-infrared wavelength lasers mainly act on the cornea, while visible and infrared wavelength lasers mainly act on the retina. The effects of laser on living organisms are photochemical, thermal, electromagnetic, and mechanical (including shock waves). The most important of these is the thermal effect. According to the laser wavelength can be divided into visible laser damage to the eye, infrared laser damage to the eye and ultraviolet laser damage to the eye. Visible lasers commonly include ruby laser, argon laser, helium-neon laser, doubled frequency Nd-YAG and doubled frequency neodymium laser. Infrared lasers can be divided into near-infrared, mid-infrared and far-infrared. Visible lasers mainly damage the retina, especially the multi-frequency Nd-YAG and multi-frequency neodymium lasers. Near-infrared lasers can damage the cornea and lens, but still mainly damage the retina, mid-infrared lasers and far-infrared lasers are mainly CO2 lasers, which have a high absorption rate of water contained in biological tissues, so they mainly damage the cornea. UV laser damage to the eye is similar to UV. 5, microwave damage Microwave frequency of 3000 ~ 3 million MHz, strong penetration, may cause cataract or retinal hemorrhage. Fourth, eye electric shock injury or lightning injury lightning or industrial electricity can cause eye electric shock injury. Powerful current through the body has an electrolytic effect on the tissue, while the tissue can be warmed up, thus destroying normal tissue. In addition, lightning or electric sparks can also produce radioactive energy and high temperatures, resulting in radiological damage and thermal burns. The severity of electric shock injury mainly depends on the nature of the current, the voltage level, the size of the resistance in the pathway, the time of electrocution, the area of electrocution, the site of electrocution and the presence of electric sparks. Electrical injury to the eye can cause skin burns and electrocution cataract. Cataracts occur 2 to 6 months after the injury. In addition, electric shock injury can also cause damage to the choroid, retina, optic nerve and extraocular muscles. Fifth, stress eye trauma usually refers to the external environment physical factors such as air pressure, acceleration, vibration, noise, oxygen poisoning caused by the change of eye injury. Sudden decrease in air pressure can appear decompression injury, mainly manifested as vision loss, visual field reduction, conjunctival or retinal hemorrhage. Acceleration can cause damage by increasing the weight of tissues and organs, changing blood distribution and displacement of tissues and organs. The eye can produce visual dysfunction under acceleration, such as decreased visual acuity, visual acuity, and even blurred vision or loss of central vision. Noise can cause a decrease in photosensitivity, a narrowing of the visual field, and a decrease in color discrimination. The effect of noise on the eye is mainly central inhibition, rather than direct damage to the eye. Vibration, on the other hand, can reduce visual acuity and reading accuracy. Section 6: Principles of Early First Aid for Ocular Trauma The consequences of an injured eye depend in large part on the early management of the injury. The correct principles of early management and proper treatment can bring the injury under control in a timely manner and transform it for the better, while reducing complications. All ocular trauma should be handled as early as possible, in the early treatment, the following principles should be mastered: First, ocular trauma combined with cranio-cerebral and systemic injury, if there is a life-threatening, life-threatening injury should be dealt with first, and then the eye treatment after the life-threatening. If in the treatment of cranial and systemic trauma, general anesthesia can also strive to deal with ocular trauma at the same time. Second, such as acid, alkali and other chemical burns, should be immediately flushed with buffer or physiological saline. If conditions do not allow, tap water or other water considered clean rinse. When rinsing, the eyelid should be turned over, the eye should be rotated to expose the fornix, and the chemical substances in the conjunctival sac should be washed out thoroughly, usually for at least 30 minutes. The main purpose is to dilute and remove the acids and bases that enter the eye as soon as possible, shorten the contact time between the chemicals and the eye tissue, and reduce the degree of burn. After the rinsing is completed, a neutralizing agent can be selected for subconjunctival injection according to the PH value of the injury-causing substance, and then the rinsing can be continued, and subconjunctival rinsing can be used if necessary. For severe alkaline burns, anterior chamber puncture is feasible, but it should be performed within 1 to 2 hours after the injury, when the anterior chamber is strongly alkaline and the damage to the iris, lens, and trabecular meshwork can be expected to be reduced after puncture. It is also feasible to make a radial incision of the conjunctiva to reduce conjunctival tension and improve conjunctival circulation. Third, such as mechanical trauma, the treatment should pay attention to the following points: 1, to find out whether it is a simple ocular appendage injury or ocular injury; 2, such as ocular injury, it should be understood whether perforation or rupture injury, such as perforation, do not apply pressure to the eye, nor rinse or apply ophthalmic ointment; 3, to understand the ocular surface or intraocular foreign body, ocular penetrating injury, often accompanied by intraocular foreign body deposit, especially when the explosion or percussion produced the shooting injury. If there is a suspicion of intraocular foreign body, first of all, the conjunctiva, cornea or sclera should be examined under the slit lamp for penetrating wounds, whether there is a foreign body embedded in the wound or debris residue, such as the frontal segment of the eye transparent, but also feasible direct ophthalmoscopy, and then should be performed X-ray, B ultrasound or CT examination to determine the presence and location of foreign bodies. Detailed history helps to understand the injury, determine the nature of the foreign body and the degree of contamination, which is extremely helpful for intraoperative treatment; 4, patients with ocular contusion should be detailed fundus examination, and visual field examination if necessary; 5, a brief record of the injury and the manner of injury, such as the nature, type, size, and shape of the injured substance, the source of the projectile force, the time, place, and surroundings of the injury, the conscious symptoms and changes in visual acuity at the time of injury; 6. Treatment of the injured eye: First, clean the trauma and probe the wound. Remove the eyelid, conjunctival sac, the wound at the dirt foreign body, especially the wood foreign body residual foreign easy to form intraorbital fistula. The scleral wound is easily covered by the elastic conjunctiva, so the bulbar conjunctiva needs to be cut when probing the scleral wound until the end of the scleral wound is explored; second, reset the torn tissue. In general, try to reset the detached tissue without cutting it easily. For detached tissues in the eye, such as pigmented membrane tissue, which is not obviously contaminated within 24 hours, it is returned after antibiotic flushing, and if it is detached vitreous, it should be cut cleanly with a cotton pad until there is no embeddedness; finally, suture the wound. In the case of simultaneous laceration of the eyelid and ocular tissue, the ocular laceration is treated first. When corneal laceration and scleral laceration coexist, the corneal wound is sutured first. Wound suturing is best performed under a microscope, and the wound is carefully sutured with microscopic sutures, and the needle should reach the full 3/4 of the tissue, up to impermeable, to prevent leakage or secondary inflammation. In corneal lacerations, the anterior chamber should be injected with non-toxic air bubble or BSS solution after the suture is completed to allow the anterior chamber to form, and the wound should be checked for leakage. The decision to perform periwound condensation or external pressure after scleral wound closure should be based on whether the location involves the retina. In the case of intraocular magnetic foreign body condensation, a magnet test is performed and aspiration is performed via the scleral wound. When suturing the eyelid wound, special attention should be paid to the lid margin alignment, which is well aligned and then sutured separately layer by layer, and try not to easily cut away the traumatic free tissue fragments and try to preserve the original tissue. For severe ruptured eye injuries with prolapsed contents, try to suture them together to preserve the eye at least, and do not easily judge the hope of functional recovery without performing eye removal; 7. Prevent infection and stop bleeding. For open wounds, systemic and local antibiotics should be applied and tetanus injections should be given. Both eyes should be bandaged to stop bleeding caused by eye activity, and hemostatic drugs should be given as appropriate to stop bleeding. Fourth, the first aid treatment of ocular fever burns, the patient should be as soon as possible to leave the heat source or remove the injury-causing objects, can be immediately flushed with saline to cool down. Burning napalm is easy to adhere to clothing or body, do not use your hands to wipe, otherwise it is easy to make the burning spread and cause burns on the hands due to adhesion to the burning. Burning parts should be submerged in water or covered with wet objects and air isolation methods to stop the burning. For phosphorus bombs burned parts, it should be quickly immersed in water, or covered with a large amount of water dipped clothing to extinguish the fire, burning stopped immediately after rinsing with a large amount of running water, and use forceps to take off the remaining phosphorus blocks. After cleaning up the trauma of phosphorus, can be applied to the eyelids and other skin trauma 5% copper sulfate solution, conjunctival sac drops 0.5 ~ 1% copper sulfate solution to make the residual phosphorus into insoluble copper sulfate and no longer absorbed by the tissue. Fifth, the eye frostbite first aid treatment, with other parts of the body frostbite treatment principles are roughly the same, the first is to remove the source of cold, the casualty moved into a warm environment. Secondly, as soon as possible with 42 ℃ warm water thawing rewarming, local topical frostbite cream after aseptic warm bandage, and can be static drops of low-molecular dextrose to improve circulation. Six, radiation injury is important in the prevention, pay attention to protection, once the damage to the eye, generally only symptomatic treatment. Seven, eye electric shock first aid, first of all, the patient from the power, such as the patient’s respiratory and cardiac arrest, should immediately perform artificial respiration and cardiac compressions, until the admission to the hospital to mechanical ventilation and cardiac defibrillation. Pay attention to the body insulation during on-site first aid; secondly, symptomatic treatment, such as shock, then according to shock treatment, eye injury treatment is roughly the same as thermal burns. Eight, the stress eye injury emphasis on prevention, the emergence of eye symptoms are symptomatic treatment. Section VII of ocular trauma first aid special equipment ocular trauma specialty is strong, therefore, the ophthalmology office to carry out initial first aid for ocular trauma, must have some special equipment. I. Examination supplies 1, spotlight flashlight; 2, slit lamp; 3, direct fundoscope; 4, indirect binocular examination glasses; 5, retinal vascular sphygmomanometer; 6, ocular protrusion meter; 7, eye shield; 8, small hole mirror; 9, Schiotz intraocular pressure meter; 10, standard visual acuity table (far and near); 11, visual field examination meter; 12, eye wash pot and water recipient; 13, lens box; 14, color vision examination Atlas; 15, oculomotor reaction test rotating drum; 16, check shadow optometry. Second, diagnostic supplies and commonly used drugs 1, 2% fluorescein sodium solution; 2, mucosal anesthetic solution (such as 1% bupivacaine); 3, tear dots dilator; 4, a full set of tear duct probe; 5, tropicamide eye solution; 6, pilocarpine eye solution; 7, antimicrobial ophthalmic ointment; 8, slide (bacterial examination smear with); 9, distilled water for injection; 10, saline; 11, open lid pull hook; 12, balanced salt solution. Commonly used instruments 1, lid opener; 2, various forceps (including microscopic forceps); 3, iris restorer; 4, universal scissors; 5, razor blade and holder; 6, small blade and handle; 7, iris hook; 8, orbital tissue pulling hook; 9, lid clamp; 10, blunt-ended irrigation needle; 11, corneal foreign body needle; 12, anterior chamber injection aspiration needle; 13, strabismus hook; 14, alcohol lamp; 15, microscopic needle holder 16, microscopic scissors; 17, 0#~10-0 sutures; 18, sterile eye pads and eye shields; 19, sterile cotton swabs or sponge pieces; 20, eye bandages; 21, lid openers; 22, binocular magnifiers or operating microscopes.