Injury	Diagnosis/treatment	Comments
Corneal abrasion	Apply topical anesthetic, then apply fluorescein strips to conjunctival sac; abraded epithelium is identified by fluorescent green stain with use of cobalt blue light.	Pain and blepharospasm may make it difficult to open eyes. Athlete may not return to play.
	Apply antibiotic ointment to affected eye; 24-hour ophthalmologic follow-up is mandatory.
Superficial corneal foreign body	Apply topical anesthetic; remove foreign body with sterile irrigating solution or moistened sterile cotton swab; never use needle. Apply antibiotic ointment; 24-hour follow-up is mandatory.	Refer if foreign body cannot be removed.
		Athlete may not return to play.
Concealed foreign object	Usually beneath upper eyelid or in lower fornix; hidden foreign object suggested by vertical linear corneal abrasions that appear after fluorescein strip staining. Evert upper eyelid; remove foreign body with sterile irrigating solution or moistened swab. If corneal abrasion is present, follow guidelines for treating corneal abrasions.	If no corneal abrasion is present, athlete may resume play. Patching is not recommended.
Superficial eyelid laceration	Rule out globe injury. Full-thickness lacerations, especially involving lid margin, warrant immediate referral. Use sterile skin closures if only skin is involved. Reapproximate superficial lacerations not involving lid margins.	Never forcibly open a lid swollen shut by edema or hematoma (could express eye contents through unsuspected laceration).
		Athlete may not resume play; refer.
		Athlete may resume play.
		Lacerations medial to pupil involve canalicular system until proved otherwise.
		Athlete may not resume play; refer.
Blunt trauma	Look for facial fractures and globe injuries. Relative afferent pupillary defect also suggests traumatic optic neuropathy. Immediately refer patient with orbital fractures.
	Acute pain, proptosis, resistance to retropulsion, and relative afferent pupillary defect suggest retrobulbar hemorrhage, which requires emergent lateral canthotomy. Refer for high-dose IV steroids.
	If no signs of orbital fracture or optic neuropathy are present, use rest, analgesics, and cold compresses to control further edema and discomfort.
Hyphema	Blood present in anterior chamber? May result in increased intraocular pressure. Restrict play, shield the eye, and refer immediately.	Rebleeding within five days carries worse prognosis than the primary bleed.
Burns	Classic signs of UV burn are intense pain, photophobia, and delay in symptom onset. Fine punctate staining with fluorescein is characteristic. Treat with systemic analgesics and topical antibiotic. Refer if epithelial defect is present.	Occurs in water/snow sports; snow blindness results from prolonged exposure to UV-B rays reflected from snow.
		Prognosis is usually excellent after treatment.