Browse categories and answer follow-up questions to refine your symptom profile.
History
Presenting complaint
Chief concern
Eye trauma context
Hyphema concern
HPI
HPI
Injury mechanism
Blunt trauma
Penetrating trauma
High velocity projectile
Chemical exposure
Thermal exposure
Time since injury
Minutes to hours
Same day
Days
Laterality
Right
Left
Vision symptoms
Decreased visual acuity
Diplopia
Photophobia
Visual field defect
Floaters
Flashes
Pain symptoms
Eye pain
Headache
Bleeding appearance
Visible blood layering
Intermittent blur that clears with position
Prior eye status
Baseline visual acuity
Contact lens use
Prior ocular surgery
OPQRST
OPQRST
Onset
Sudden
Progressive after injury
Provocation and palliation
Worse with light
Worse with eye movement
Better with eye closed
Better with dark room
Quality
Sharp
Aching
Foreign body sensation
Region and radiation
Eye
Periorbital
Frontal headache
Severity
Pain scale 0 to 10
Vision change mild to severe
Timing
Constant
Intermittent
Worsening at night
Associated symptoms
Associated symptoms
Nausea
Vomiting
Dizziness
Syncope
Facial numbness
Epistaxis
Context and triggers
Context and triggers
Sports injury
Assault
Fall
Motor vehicle collision
Workplace metal grinding
Prior episodes and baseline
Prior episodes and baseline
Prior hyphema
Prior glaucoma or elevated intraocular pressure
Prior retinal detachment
Baseline corrective lenses
Alarm Features
Immediate escalation triggers
Immediate escalation triggers
Suspected open globe
Peaked pupil
Extruded uveal tissue
360 degree subconjunctival hemorrhage
Positive Seidel test
Severe vision loss
Light perception only
No light perception
Retrobulbar hematoma concern
Proptosis
Tense orbit
Rapidly decreasing vision
Afferent pupillary defect
Chemical injury
Pain out of proportion
Persistent epithelial defect risk
Orbital compartment syndrome
Intraocular pressure markedly elevated with vision threat
Ophthalmology unavailable for time critical decompression
High risk history features
High risk history features
High velocity projectile
Hammering or metal on metal
Explosive mechanism
Contact lens at time of injury
Vital sign danger thresholds
Vital sign danger thresholds
Severe hypertension with hyphema
Persistent vomiting with head trauma concern
High risk exam findings
High risk exam findings
Hyphema grade 3 or 4
Total hyphema
Elevated intraocular pressure
Corneal blood staining concern
Lens dislocation
Traumatic mydriasis with severe photophobia
Medications
Current medications and adherence
Current medications and adherence
Anticoagulants
Warfarin
Direct oral anticoagulants
Antiplatelets
ASA
Clopidogrel
NSAIDs use
Ibuprofen
Naproxen
Glaucoma drops
Beta blocker drops
Prostaglandin analogs
Steroids
Systemic
Topical ocular
ED therapies and contraindications
ED therapies and contraindications
Analgesics
Acetaminophen PO 1000 mg once
Maximum 3000 mg per 24 hours local protocol dependent
Antiemetics
Ondansetron ODT 4 mg once
Repeat every 8 hours as needed
Cycloplegic drops
Cyclopentolate 1 percent
1 drop every 8 to 12 hours local protocol dependent
Topical steroid drops
Prednisolone acetate 1 percent
Frequency per ophthalmology
Intraocular pressure lowering drops
Timolol 0.5 percent
1 drop twice daily if not contraindicated
Avoid in asthma with active bronchospasm
Avoid
NSAIDs
ASA
Miotic agents in hyphema
Diet
Recent intake and vomiting risk
Recent intake and vomiting risk
Poor oral intake
Dehydration symptoms
Nausea and emesis frequency
Exposures
Exposures
Caffeine and energy drinks
Alcohol use around injury
Review of Systems
Eye and neuro
Eye and neuro
Eye pain
Photophobia
Headache
Nausea
Vomiting
Focal neurologic symptoms
ENT and face
ENT and face
Facial pain
Epistaxis
Jaw malocclusion
Rhinorrhea
Cardiopulmonary and systemic
Cardiopulmonary and systemic
Chest pain
Shortness of breath
Fever
Syncope
Collateral History and Family History
Collateral and supervision reliability
Collateral and supervision reliability
Witness description of mechanism
Protective eyewear use
Ability to comply with activity restriction
Family history and inherited risk
Family history and inherited risk
Sickle cell disease or trait
Bleeding disorders
Risk Factors
Patient factors
Patient factors
Sickle cell disease or trait
Known coagulopathy
Anticoagulation therapy
Uncontrolled hypertension
Injury factors
Injury factors
High velocity foreign body risk
Penetrating injury risk
Concurrent head trauma risk
Ocular factors
Ocular factors
Prior glaucoma
Prior eye surgery
Monocular vision
Differential Diagnosis
Life threatening
Life threatening
Open globe injury
Pain with low intraocular pressure
Peaked pupil
Retrobulbar hematoma with orbital compartment syndrome
Proptosis
Afferent pupillary defect
Orbital fracture with muscle entrapment
Diplopia
Bradycardia with upgaze
Intraocular foreign body
Metal on metal mechanism
Small entry wound
Common
Common
Traumatic hyphema
Layered blood in anterior chamber
Rebleed risk 2 to 7 days
Corneal abrasion
Foreign body sensation
Fluorescein uptake
Traumatic iritis
Consensual photophobia
Cells and flare
Conjunctival hemorrhage
Painless red eye
Normal vision
Less common
Less common
Lens dislocation
Irregular anterior chamber depth
Monocular diplopia
Retinal detachment
Curtain vision
Flashes and floaters
Vitreous hemorrhage
Sudden floaters
Hazy fundus view
Traumatic glaucoma
Elevated intraocular pressure
Corneal edema
Past Medical History
Relevant medical conditions
Relevant medical conditions
Sickle cell disease (D57.1)
Sickle cell trait (D57.3)
Bleeding disorder
Hypertension (I10)
Diabetes mellitus (E11.9)
Ocular history
Ocular history
Glaucoma (H40.9)
Cataract surgery
LASIK or refractive surgery
Prior retinal detachment
Physical Exam
Primary survey and general
Primary survey and general
Airway and breathing stability
Hemodynamic stability
Mental status change
Eye exam safety sequence
Eye exam safety sequence
Open globe exclusion before pressure
Avoid tonometry if open globe possible
Avoid eyelid retraction pressure if open globe possible
Visual function
Visual function
Visual acuity
Unaided
With correction
Pupils
Size and symmetry
Afferent pupillary defect
Extraocular movements
Pain with movement
Diplopia
Visual fields
Confrontation fields
Field cut pattern
External and anterior segment
External and anterior segment
Periorbital
Ecchymosis
Lacerations
Conjunctiva and sclera
Subconjunctival hemorrhage
Chemosis
Cornea
Foreign body
Abrasion
Anterior chamber
Hyphema layering height
Cells and flare
Iris and lens
Irregular pupil
Lens position
Posterior segment
Posterior segment
Fundus view quality
Optic disc appearance
Retinal tear or detachment signs
Intraocular pressure
Intraocular pressure
Measurement only if globe intact
Elevated pressure thresholds for escalation
Lab Studies
Bleeding risk and comorbidity labs
Bleeding risk and comorbidity labs
INR if warfarin use
CBC if significant bleeding concern
Basic metabolic panel if acetazolamide considered
Special populations
Special populations
Sickle cell screen if status unknown local protocol dependent
Pregnancy test if imaging or meds influenced
Imaging
Scoring Systems
Prognosis and classification tools
Ocular Trauma Score
Use for open globe and severe trauma prognosis
Not for isolated minor anterior segment injury
Birmingham Eye Trauma Terminology
Open globe versus closed globe classification
Guides communication and documentation
MRI
MRI considerations
Contraindicated when metallic intraocular foreign body possible
Indications for soft tissue and optic nerve pathology when foreign body excluded
CT
CT orbit and facial bones
Noncontrast CT orbit
Suspected orbital fracture
Suspected intraocular foreign body
CT head
Concerning head trauma features
Altered mental status
Interpretation pearls
Extraocular muscle entrapment
Globe contour abnormality
Ultrasound
Ocular ultrasound
Only if globe rupture excluded
Retinal detachment signs
Vitreous hemorrhage signs
Special Tests
Bedside ocular tests
Bedside ocular tests
Fluorescein staining
Corneal abrasion pattern
Dendritic lesion alternative diagnosis
Seidel test
Aqueous leak detection
Avoid if gross open globe instability
Slit lamp and gonioscopy
Slit lamp and gonioscopy
Slit lamp exam
Hyphema grading
Cells and flare
Gonioscopy
Angle recession evaluation
Typically outpatient ophthalmology
Tonometry
Tonometry
Contraindicated if open globe suspected
Repeat measurements for rising intraocular pressure trend
ECG
When relevant in eye trauma
ECG context
Syncope associated injury
Oculocardiac reflex with suspected entrapment
Bradycardia during extraocular movement testing
Assessment
Working diagnosis and severity
Working diagnosis
Traumatic hyphema (S05.1)
Grade estimate
Microhyphema
Layered hyphema less than one third
Layered hyphema one third to one half
Layered hyphema more than one half
Total hyphema
Complications to rule out
Complications to rule out
Open globe injury
Elevated intraocular pressure
Rebleed risk window
Corneal blood staining risk
Angle recession glaucoma risk
Special populations risk stratification
Special populations risk stratification
Sickle cell disease or trait
Higher risk optic nerve ischemia at lower intraocular pressure
Earlier ophthalmology escalation threshold
Anticoagulation
Higher rebleed risk
Reversal decisions local protocol dependent
Plan
First 5 minutes
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
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
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
Reassessment loop
Visual acuity trend
Pain trend
Hyphema height trend
Intraocular pressure trend if measured safely
Disposition
Ophthalmology consultation and follow up timing
Ophthalmology consultation and follow up timing
Same day ophthalmology
Any layered hyphema
Elevated intraocular pressure
Immediate transfer
Open globe concern
Orbital compartment syndrome concern
Admission and observation criteria
Admission and observation criteria
Total hyphema
Hyphema grade 3 or 4
Uncontrolled intraocular pressure
Sickle cell disease or trait with hyphema
Nonadherence risk to activity restriction
Discharge criteria
Discharge criteria
Stable vision
Mild hyphema with reliable follow up
Controlled pain and nausea
Clear instructions and eye shield available
Discharge Instructions
Copy discharge instructions
Copy discharge instructions
Diagnosis
You have bleeding in the front chamber of the eye after trauma
This can worsen again within the next week
Eye protection
Keep the rigid eye shield on except for drops
Do not rub or press on the eye
Position and activity
Sleep with head raised
Avoid heavy lifting
Avoid straining
Avoid sports until cleared
Medications
Use eye drops exactly as prescribed
Use acetaminophen for pain
Do not take ibuprofen, naproxen, or ASA unless instructed
Follow up
Ophthalmology appointment
Timing per ED plan
Return to ED now for
Worsening vision
Increasing eye pain
New nausea or vomiting
New flashing lights
New curtain or shadow in vision
Eye swelling with bulging appearance
References
Guidelines and key sources
Guidelines and key sources
American Academy of Ophthalmology
Eye trauma and hyphema clinical guidance
Year varies local protocol dependent
Wills Eye Manual
Ocular trauma management approach
Updated editions local protocol dependent
British Ocular Trauma Society
Ocular trauma standards and terminology
Year varies local protocol dependent
Ocular Trauma Score
Prognostic tool validation studies
Use in severe ocular trauma
SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.