›First 5 minutes
›Eye shield
›Rigid shield
›Avoid pressure patch if hyphema or open globe concern
›Head of bed elevation
›30 to 45 degrees
›Continuous while resting
›Antiemetic to prevent Valsalva
›Ondansetron dosing per Medications section
›Escalate if ongoing emesis
›Analgesia without platelet inhibition
›Acetaminophen dosing per Medications section
›Opioid if severe pain local protocol dependent
›Diagnostic sequencing
›Visual acuity before drops if possible
›Open globe screen before tonometry
›Slit lamp with hyphema grading
›CT orbit if foreign body or fracture concern
›Hyphema management
›Activity restriction
›Bed rest relative
›Avoid heavy lifting and straining
›Cycloplegia
›Cyclopentolate 1 percent per ophthalmology
›Alternatives local protocol dependent
›Topical steroids
›Prednisolone acetate 1 percent per ophthalmology
›Avoid if corneal epithelial defect without ophthalmology guidance
›Intraocular pressure control
›Timolol 0.5 percent if elevated pressure and no contraindications
›Add brimonidine 0.2 percent local protocol dependent
›Avoid carbonic anhydrase inhibitors in sickle cell disease local protocol dependent
›Bleeding avoidance
›Avoid NSAIDs and ASA
›Review anticoagulants and antiplatelets
Orbital compartment syndrome pathway
›Orbital compartment syndrome pathway
›Time critical criteria
›Rapid vision decline
›Proptosis with tense orbit
›Lateral canthotomy and cantholysis
›If ophthalmology unavailable and vision threatened local protocol dependent
›Post procedure intraocular pressure reassessment
›Reassessment loop
›Visual acuity trend
›Pain trend
›Hyphema height trend
›Intraocular pressure trend if measured safely