Eye Emergencies and Injuries Practice Questions

30 multiple-choice questions on Eye emergencies and injuries for paramedic and EMT students, from Chapter 20 (Diseases of the Eyes, Ears, Nose, and Throat). Read each question, pick your answer, then tap Show answer to check it and read the explanation.

30 practice questions

1. A 34-year-old man was splashed in both eyes with a drain cleaner. He is screaming in pain. What is your first priority after scene safety?

   1. A. Transport and irrigate at the ED
   2. B. Check visual acuity in each eye
   3. C. Apply bilateral dry patches
   4. D. Begin immediate copious irrigation
   Show answer

   Answer: D. Begin immediate copious irrigation

   Alkali burns cause liquefactive necrosis and continue to penetrate tissue; immediate, prolonged irrigation is the priority. Acuity testing should not delay irrigation.

2. Why are alkali eye burns generally more damaging than acid burns?

   1. A. Acids are always neutralized by tears
   2. B. Alkalis cause only surface coagulation
   3. C. Acids cannot reach the cornea
   4. D. Alkalis penetrate deeper into tissue
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   Answer: D. Alkalis penetrate deeper into tissue

   Alkalis cause liquefactive necrosis, allowing continued deep penetration. Acids cause coagulation necrosis, which tends to limit depth of injury.

3. When irrigating a chemical eye injury, in which direction should fluid flow?

   1. A. Straight onto the center of the cornea
   2. B. From the lower lid upward
   3. C. From the lateral corner inward
   4. D. From the medial corner outward
   Show answer

   Answer: D. From the medial corner outward

   Irrigate from the nose side (medial canthus) laterally so contaminated fluid does not run into the unaffected eye or down the tear duct.

4. For an alkali burn to the eye, how long should irrigation generally continue?

   1. A. At least 20 minutes
   2. B. About 2 minutes
   3. C. Until the pain eases
   4. D. About 5 minutes per eye
   Show answer

   Answer: A. At least 20 minutes

   Alkali burns generally need at least 20 minutes of irrigation, often longer, and irrigation should continue during transport. About 2 minutes or about 5 minutes per eye is far too short for an alkali, and the eye can feel better before the chemical is gone, so pain easing is not a reliable endpoint.

5. Which solution is appropriate for irrigating a chemical eye burn in the field?

   1. A. Sodium bicarbonate solution
   2. B. Normal saline or clean water
   3. C. Hydrogen peroxide
   4. D. Diluted vinegar solution
   Show answer

   Answer: B. Normal saline or clean water

   Flush with large volumes of normal saline, lactated Ringer's, or clean water. Never attempt to neutralize a chemical, because the reaction can generate heat and more injury.

6. A welder complains of severe bilateral eye pain and tearing that began several hours after work without a mask. What is the likely cause?

   1. A. Bilateral hyphema
   2. B. Acute angle-closure glaucoma
   3. C. Retinal detachment
   4. D. Ultraviolet keratitis
   Show answer

   Answer: D. Ultraviolet keratitis

   UV light from welding arcs or sun on snow causes painful corneal burns, typically 3 to 10 hours after exposure. Care includes covering both eyes, limiting light, and transport.

7. A worker was struck in the eye by a metal fragment from a grinder. A 2-cm sliver protrudes from the globe. How should you manage it?

   1. A. Pad the eye firmly against the object
   2. B. Stabilize the object and cover both eyes
   3. C. Remove it and apply direct pressure
   4. D. Irrigate the object out with saline
   Show answer

   Answer: B. Stabilize the object and cover both eyes

   Impaled objects in the eye are never removed in the field. Stabilize with gauze and a protective cup, and cover the uninjured eye to reduce sympathetic eye movement.

8. Why is the uninjured eye often covered when treating a penetrating eye injury?

   1. A. To reduce intraocular pressure directly
   2. B. To prevent spread of infection
   3. C. To limit sympathetic eye movement
   4. D. To allow testing of consensual reflex
   Show answer

   Answer: C. To limit sympathetic eye movement

   The eyes move together, so movement of the uninjured eye moves the injured one. Covering both reduces movement and further injury. Explain this to the patient, who will be unable to see.

9. A 25-year-old was punched in the eye. You see blood layering in the lower anterior chamber in front of the iris. This finding is called:

   1. A. Subconjunctival hemorrhage
   2. B. Hordeolum
   3. C. Hyphema
   4. D. Retinal detachment
   Show answer

   Answer: C. Hyphema

   Hyphema is blood in the anterior chamber, usually from blunt trauma, and can threaten vision. Subconjunctival hemorrhage is blood under the conjunctiva over the sclera.

10. How should you position a patient with a hyphema and no spinal injury concerns?

    1. A. Prone with the head turned aside
    2. B. Head elevated 45 degrees
    3. C. Supine with the legs raised
    4. D. Trendelenburg position
    Show answer

    Answer: B. Head elevated 45 degrees

    Elevating the head allows blood to settle in the lower anterior chamber and helps limit intraocular pressure rises. Avoid activities that increase pressure.

11. A patient has a bright red patch over the white of one eye after a coughing fit. Vision is normal and there is no pain. This is most likely:

    1. A. Traumatic globe rupture
    2. B. Acute angle-closure glaucoma
    3. C. Acute anterior uveitis
    4. D. Subconjunctival hemorrhage
    Show answer

    Answer: D. Subconjunctival hemorrhage

    Subconjunctival hemorrhage looks alarming but is usually benign, caused by coughing, sneezing, straining, or minor trauma. It resolves on its own over a couple of weeks.

12. A 70-year-old man has sudden painless loss of vision in one eye. He has atrial fibrillation. Which condition is most likely?

    1. A. Central retinal artery occlusion
    2. B. Acute angle-closure glaucoma
    3. C. Conjunctivitis
    4. D. Corneal abrasion
    Show answer

    Answer: A. Central retinal artery occlusion

    Central retinal artery occlusion presents as sudden, painless monocular vision loss, often from emboli (as with atrial fibrillation or carotid disease). It is a true emergency, similar to a stroke of the eye.

13. A 3-day-old has very swollen eyelids with thick yellow pus that returns quickly after wiping. The mother had no prenatal care. What should you suspect?

    1. A. A blocked tear duct
    2. B. Irritation from eye ointment
    3. C. Viral pinkeye from a cold
    4. D. A gonococcal eye infection
    Show answer

    Answer: D. A gonococcal eye infection

    Heavy, rapidly returning pus with swollen lids in the first days of life suggests gonococcal ophthalmia neonatorum, caught from the mother at birth. It can perforate the cornea within a day, so the newborn needs emergency evaluation and IV antibiotics. A blocked tear duct causes tearing and mild crusting, irritation from eye ointment is mild and brief, and viral pinkeye is not the likely cause of this much pus in a newborn.

14. In acute angle-closure glaucoma, what causes the rise in intraocular pressure?

    1. A. Swelling of the lacrimal gland
    2. B. Bleeding into the retina
    3. C. Leakage of vitreous humor
    4. D. Blocked drainage of aqueous humor
    Show answer

    Answer: D. Blocked drainage of aqueous humor

    Narrowing of the angle between iris and cornea prevents aqueous humor from draining, so pressure rises quickly. Dim light, which dilates the pupil, may trigger an attack.

15. A patient reports flashes of light, many new floaters, and a shadow spreading across part of his vision. What should you suspect?

    1. A. Corneal abrasion
    2. B. Retinal detachment
    3. C. Orbital cellulitis
    4. D. Conjunctivitis
    Show answer

    Answer: B. Retinal detachment

    Retinal detachment classically presents with painless flashes, floaters, and a curtain or shadow over the visual field. It requires urgent ophthalmologic evaluation.

16. A patient reports something in her eye after a windy day. She has pain, tearing, and a gritty feeling. Fluorescein is not available. What is the likely injury?

    1. A. Central retinal artery occlusion
    2. B. Hyphema
    3. C. Retinal detachment
    4. D. Corneal abrasion
    Show answer

    Answer: D. Corneal abrasion

    Corneal abrasions cause pain, a foreign body sensation, tearing, and photophobia. Retinal problems typically cause painless visual changes.

17. A loose foreign body is visible on the conjunctiva of a cooperative patient. What is the most appropriate first attempt at removal?

    1. A. Removal with tweezers
    2. B. Rubbing the eye with the eyelid closed
    3. C. Gentle irrigation with saline
    4. D. Removal with a cotton swab on the cornea
    Show answer

    Answer: C. Gentle irrigation with saline

    Gentle irrigation is the safest method for loose foreign bodies. Never touch the cornea with swabs or instruments, and an embedded object should not be removed in the field.

18. Following a high-speed impact, a patient's globe appears misshapen with a teardrop pupil and dark tissue protruding. What should you do?

    1. A. Push the tissue back into the globe
    2. B. Apply a firm pressure patch
    3. C. Irrigate the eye vigorously
    4. D. Cover with a rigid shield, no pressure
    Show answer

    Answer: D. Cover with a rigid shield, no pressure

    These are signs of an open globe. Protect the eye with a rigid shield that does not press on the globe, cover both eyes, elevate the head, and prevent vomiting and straining.

19. For a suspected ruptured globe, which intervention helps prevent extrusion of eye contents?

    1. A. Give an antiemetic per protocol
    2. B. Place the patient head-down
    3. C. Apply direct pressure to the globe
    4. D. Encourage the patient to cough
    Show answer

    Answer: A. Give an antiemetic per protocol

    Vomiting, coughing, and straining raise intraocular pressure and can push contents out. Antiemetics per protocol, elevating the head, and avoiding pressure on the globe all help.

20. A patient struck in the face with a baseball cannot look upward with one eye and reports double vision. Numbness is present below the eye. What injury do you suspect?

    1. A. Basilar skull fracture with CSF leak
    2. B. Orbital floor (blowout) fracture
    3. C. Traumatic corneal abrasion
    4. D. Retinal detachment from impact
    Show answer

    Answer: B. Orbital floor (blowout) fracture

    Blowout fractures can trap the inferior rectus muscle, limiting upward gaze, causing diplopia, and injuring the infraorbital nerve, which causes numbness of the cheek and upper lip.

21. A patient's eye is protruding from the socket after trauma (avulsed globe). What is the correct care?

    1. A. Cover with a dry gauze pad
    2. B. Cover the injured eye, leave the other
    3. C. Cover with moist dressing and a cup
    4. D. Gently push the eye back into the socket
    Show answer

    Answer: C. Cover with moist dressing and a cup

    Never attempt to replace an avulsed eye. Cover it with a moist sterile dressing and a protective cup, cover the other eye to limit movement, and transport supine or as protocol directs. Dry gauze can stick to and dry the exposed tissue, and leaving the uninjured eye uncovered lets both eyes keep moving together.

22. A child has a red, crusted eye with discharge and itching, and several classmates have similar symptoms. What is most likely?

    1. A. Conjunctivitis
    2. B. Hyphema
    3. C. Acute glaucoma
    4. D. Retinal detachment
    Show answer

    Answer: A. Conjunctivitis

    Conjunctivitis is inflammation of the conjunctiva, often viral or bacterial and highly contagious. Use good hand hygiene and PPE.

23. A small painful red bump at the eyelid margin with localized swelling is most likely a:

    1. A. Subconjunctival bleed
    2. B. Stye (hordeolum)
    3. C. Pterygium growth
    4. D. Chalazion (meibomian cyst)
    Show answer

    Answer: B. Stye (hordeolum)

    A stye (hordeolum) is an acute, painful infection of a gland at the eyelid margin. A chalazion is a painless, chronic blocked meibomian gland that is farther from the lid edge.

24. A painless, firm nodule within the eyelid, away from the lid edge, that developed over weeks is most consistent with:

    1. A. Hordeolum
    2. B. Conjunctivitis
    3. C. Chalazion
    4. D. Dacryocystitis
    Show answer

    Answer: C. Chalazion

    A chalazion is a blocked meibomian gland that becomes a firm, typically painless lump. A hordeolum is acute and painful.

25. A patient has a swollen, red eyelid, fever, pain with eye movement, and decreased vision. Which condition is most concerning?

    1. A. Subconjunctival hemorrhage
    2. B. Allergic conjunctivitis
    3. C. Orbital cellulitis
    4. D. Simple stye
    Show answer

    Answer: C. Orbital cellulitis

    Pain with eye movement, proptosis, vision changes, and fever suggest orbital cellulitis, a serious infection that can spread to the brain. It needs prompt transport and IV antibiotics.

26. An eyelid laceration is bleeding moderately. The globe appears intact. How should you control bleeding?

    1. A. Firm pressure directly on the globe
    2. B. Ice pack pressed onto the lid
    3. C. Light pressure with a moist dressing
    4. D. Dry gauze taped down tightly over the lid
    Show answer

    Answer: C. Light pressure with a moist dressing

    Eyelid bleeding can be controlled with light pressure, but never press on the globe itself. Cover with a moist dressing to protect exposed tissue. Pressing an ice pack onto the lid or taping gauze down tightly passes pressure to the eye, and dry gauze can stick to the wound.

27. A patient has a thermal burn to the face and eyelids from a flash fire. How should the eyes be managed?

    1. A. Cover the worse eye with dry gauze
    2. B. Cover both eyes with moist dressings
    3. C. Cool the eyes with ice packs
    4. D. Force the eyelids open to inspect the globe
    Show answer

    Answer: B. Cover both eyes with moist dressings

    Eyelids often close reflexively and protect the globe. Cover both eyes with moist, sterile dressings and do not force the lids open. Covering one eye lets both keep moving, dry gauze sticks to burned skin, and ice packs can freeze injured tissue and press on the globe.

28. A laser pointer injury to the eye most commonly damages which structure?

    1. A. Cornea
    2. B. Retina
    3. C. Sclera
    4. D. Lens
    Show answer

    Answer: B. Retina

    Lasers focus intense light on the retina, potentially causing permanent burns and visual deficits. These injuries may be painless. The visible beam passes through the clear cornea and lens, which focus it onto the retina rather than absorbing it, unlike ultraviolet light, which burns the cornea, and the sclera is not in the path of the focused beam.

29. A 65-year-old diabetic patient reports sudden painless blurry vision in one eye, and the view seems to be filled with blood-red haze. What condition is most likely?

    1. A. Corneal abrasion from rubbing
    2. B. Vitreous hemorrhage
    3. C. Allergic conjunctivitis flare
    4. D. Hordeolum of the upper lid
    Show answer

    Answer: B. Vitreous hemorrhage

    Diabetic and hypertensive retinopathy can lead to bleeding into the retina or vitreous, causing painless vision loss or floaters. It requires ophthalmology evaluation.

30. Which statement about topical anesthetic eye drops is correct?

    1. A. They are safe for daily home use
    2. B. Repeated use can delay healing
    3. C. They treat the cause of abrasions
    4. D. They lower intraocular pressure
    Show answer

    Answer: B. Repeated use can delay healing

    Agents such as tetracaine can relieve pain to permit irrigation or examination, per protocol, but repeated use impairs corneal healing and masks injury, so patients should not be sent home with them.