Eye Injuries Practice Questions

25 multiple-choice questions on Eye injuries for paramedic and EMT students, from Chapter 34 (Face and Neck Trauma). Read each question, pick your answer, then tap Show answer to check it and read the explanation.

25 practice questions

1. When assessing any patient with an eye injury, which assessment should be documented as early as possible?

   1. A. Intraocular pressure
   2. B. Color perception in each eye
   3. C. Visual acuity in each eye
   4. D. Corneal sensation
   Show answer

   Answer: C. Visual acuity in each eye

   Visual acuity is the vital sign of the eye and is the baseline against which later changes are measured. Intraocular pressure requires equipment and must not be measured if the globe might be open.

2. A 28-year-old welder has a small particle of metal on the white of his eye but no impalement. The best way to remove it is to:

   1. A. Irrigate the eye with sterile saline
   2. B. Lift it off with a cotton-tipped swab
   3. C. Have him rub the eye with the lid closed
   4. D. Pick it out with sterile forceps
   Show answer

   Answer: A. Irrigate the eye with sterile saline

   Gentle irrigation flushes loose foreign bodies without scratching the cornea. Rubbing the eye drags the particle across the cornea and causes abrasions.

3. When irrigating an eye with a loose foreign body, the fluid should flow from the:

   1. A. Outer corner toward the bridge of the nose
   2. B. Lower lid toward the upper lid
   3. C. Inner corner toward the outer corner
   4. D. Center of the cornea outward
   Show answer

   Answer: C. Inner corner toward the outer corner

   Irrigating from the medial to the lateral canthus carries debris away from the other eye and the tear duct. Flowing toward the nose can wash the contaminant into the unaffected eye.

4. A foreign body is embedded in the cornea of a patient's eye. You should:

   1. A. Remove it with a moistened swab
   2. B. Cover both eyes and transport
   3. C. Irrigate forcefully to dislodge it
   4. D. Have the patient blink repeatedly
   Show answer

   Answer: B. Cover both eyes and transport

   An embedded corneal foreign body is removed by a physician using magnification, so cover the eyes loosely and transport. Wiping it with a swab can push it deeper or scrape the cornea, forceful irrigation will not dislodge an embedded object and can drive it in further, and repeated blinking drags it across the corneal surface.

5. Both eyes are usually covered after a serious injury to one eye because:

   1. A. Light damages the uninjured eye
   2. B. The uninjured eye shares its blood supply
   3. C. It reduces tear flow in both eyes
   4. D. The eyes move together
   Show answer

   Answer: D. The eyes move together

   When the uninjured eye looks around, the injured eye follows, which can worsen bleeding or extrusion of contents. Covering both eyes reduces this sympathetic movement; explain this to the patient, who will be unable to see. The eyes do not share a blood supply that a patch would protect, and covering them does not meaningfully reduce tearing.

6. A laceration of the upper eyelid has yellow fatty tissue protruding from it. This finding suggests:

   1. A. A minor cut through the skin alone
   2. B. A normal layer under eyelid skin
   3. C. An allergic reaction of the eyelid
   4. D. A deep wound, maybe into the globe
   Show answer

   Answer: D. A deep wound, maybe into the globe

   Fat visible in an upper-lid wound means the orbital septum has been penetrated, so the wound is deep and the globe or levator muscle may be injured. Protect with a shield, do not press, and transport. The eyelid has very little subcutaneous fat, so visible fat is never a superficial finding.

7. A man was sprayed in the face with pepper spray by police. His eyes are burning and tearing. The best care is to:

   1. A. Apply milk and keep the eyes closed
   2. B. Irrigate with water; reassure him
   3. C. Rub the eyes to help the tears flow
   4. D. Patch the eyes firmly for transport
   Show answer

   Answer: B. Irrigate with water; reassure him

   Oleoresin capsicum causes intense but usually temporary burning. Remove contaminated clothing and contact lenses, irrigate with cool water or saline, and reassure; most symptoms fade within an hour. Persistent pain or vision change needs evaluation for corneal abrasion. Rubbing spreads the irritant, and patching traps it.

8. Which type of chemical causes the most severe eye injury because it continues to penetrate tissue?

   1. A. Alkali
   2. B. Acid
   3. C. Hydrocarbon
   4. D. Alcohol
   Show answer

   Answer: A. Alkali

   Alkalis cause liquefaction necrosis and keep penetrating the eye until removed, while acids coagulate proteins and tend to limit their own spread. This is why alkali burns need prolonged irrigation.

9. For a significant alkali splash to the eye, irrigation should generally continue for at least:

   1. A. 2 minutes
   2. B. 5 minutes
   3. C. 20 minutes
   4. D. 10 minutes
   Show answer

   Answer: C. 20 minutes

   Alkalis keep penetrating the eye until they are washed out, so start irrigating immediately and continue for at least 20 minutes, and keep going during transport. Ophthalmology guidance goes further: irrigate until the tear pH returns to about 7.0 to 7.5, which often takes 30 minutes or more after an alkali, then recheck it because trapped particles can raise it again. Two, 5, or 10 minutes stops while alkali is still in the tissue and lodged under the lids, which risks permanent corneal and limbal damage.

10. A woman calls because a cleaning chemical splashed in her eye. She does not know what it is. In addition to irrigating, you should:

    1. A. Wait to irrigate until you know the chemical
    2. B. Bring the container or label to the hospital
    3. C. Neutralize it with a weak acid or vinegar
    4. D. Let her rinse only once at the kitchen sink
    Show answer

    Answer: B. Bring the container or label to the hospital

    Irrigation should never wait for identification, but the product label or safety data sheet tells the hospital whether it was acid or alkali and guides further care. Neutralizing agents cause heat and further injury, and a single brief rinse is not enough.

11. A Morgan lens is used in the prehospital setting to:

    1. A. Measure visual acuity
    2. B. Protect an impaled object in the eye
    3. C. Remove a contact lens
    4. D. Irrigate the eye continuously
    Show answer

    Answer: D. Irrigate the eye continuously

    The Morgan lens is shaped like a large contact lens, sits over the cornea, and connects to IV tubing to give hands-free, continuous irrigation. Visual acuity is measured with an eye chart, not a lens. It must never be placed over an impaled object or a possible open globe. It is not a tool for removing contact lenses, which should come out before it is inserted.

12. A topical ophthalmic anesthetic such as tetracaine is used in the field mainly to:

    1. A. Allow the patient to tolerate irrigation
    2. B. Treat a corneal infection
    3. C. Reduce the intraocular pressure
    4. D. Dilate the pupil for a retinal examination
    Show answer

    Answer: A. Allow the patient to tolerate irrigation

    Topical anesthetics relieve the blepharospasm and pain that prevent effective irrigation. They are not given to patients to take home, because repeated use delays corneal healing.

13. A 30-year-old with sickle cell trait has a hyphema after a blow to the eye. Compared with other patients, he is at higher risk of:

    1. A. Faster clearing of the blood within hours
    2. B. Retinal detachment within the hour
    3. C. Rising eye pressure and optic nerve damage
    4. D. A sickle crisis in the bones from the blow
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    Answer: C. Rising eye pressure and optic nerve damage

    In sickle cell disease and trait, red cells sickle in the anterior chamber and block drainage, so eye pressure can rise quickly and damage the optic nerve even at modest levels. Report the history; these patients need close specialist follow-up. Trait does not make the blood clear faster, it does not cause retinal detachment within the hour, and people with trait rarely have pain crises; the eye pressure is the danger.

14. After a high-speed crash, a patient's eye has bright red swelling of the conjunctiva all the way around the cornea, bulging over the lids. You should:

    1. A. Treat it as a possible ruptured globe
    2. B. Reassure her it is a harmless bruise
    3. C. Irrigate the eye with large volumes
    4. D. Press on the eye to reduce the swelling
    Show answer

    Answer: A. Treat it as a possible ruptured globe

    A small subconjunctival hemorrhage after coughing is harmless, but extensive 360-degree hemorrhage with swelling (chemosis) after major trauma can hide a rupture of the globe. Shield the eye without pressure, avoid irrigation, and transport. Pressure could expel eye contents.

15. Two days after being struck in the eye by a ball, a patient has a deep ache, sensitivity to light, and a small pupil on that side, with no blood in the eye. The most likely cause is:

    1. A. Retinal detachment
    2. B. Optic neuritis
    3. C. Traumatic iritis
    4. D. Acute angle-closure glaucoma
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    Answer: C. Traumatic iritis

    Inflammation of the iris after blunt trauma (traumatic iritis) typically appears a day or more later with aching pain, photophobia, and a constricted, sluggish pupil, and needs ophthalmology treatment. Retinal detachment causes flashes, floaters, and a curtain-like shadow, without much pain. Angle-closure glaucoma produces a mid-dilated, fixed pupil rather than a small one, and optic neuritis causes vision loss and pain with eye movement without a constricted pupil.

16. A laceration at the inner (nasal) end of the lower eyelid near the nose is important mainly because it may involve the:

    1. A. Optic nerve
    2. B. Eyelid's lashes
    3. C. Upper eyelid muscle
    4. D. Tear drainage duct
    Show answer

    Answer: D. Tear drainage duct

    The tear drainage canaliculus runs through the inner corner of the lids, so lacerations there need specialist repair to prevent chronic tearing. Cover with a moist dressing without pressure and transport. The optic nerve is deep in the orbit, lashes are along the lid margin, and the upper lid muscle is not in the lower lid.

17. An unconscious trauma patient's eyes remain partly open during a long transport. To protect them, you should:

    1. A. Leave them open to monitor the pupils
    2. B. Close the lids gently under moist gauze
    3. C. Apply firm pressure patches to the eyes
    4. D. Rinse them with tap water every minute
    Show answer

    Answer: B. Close the lids gently under moist gauze

    Without blinking, the cornea dries and can ulcerate. Gently close the lids and cover them with moist gauze or tape, checking pupils as needed. Firm pressure patches risk injury, especially if a globe injury is present, and frequent tap-water rinsing is unnecessary.

18. A patient has a fishhook embedded in his upper eyelid. The eye itself appears uninjured. You should:

    1. A. Pull the hook out the way it went in
    2. B. Push the hook through and cut the barb
    3. C. Stabilize the hook; cover the eyes
    4. D. Have him blink hard to work it loose
    Show answer

    Answer: C. Stabilize the hook; cover the eyes

    An object embedded near the eye is stabilized in place, both eyes are covered to limit movement, and the patient is transported for removal by a physician, since the hook may involve the globe or lid margin. Pulling or pushing it through risks further injury, and blinking moves it.

19. A patient with an eye injury also needs rapid sequence intubation for a head injury. If an open globe is possible, which practice is generally advised?

    1. A. Patch the eye firmly before RSI
    2. B. Hyperventilate to lower eye pressure
    3. C. Intubate nasally to spare the eye
    4. D. Prevent coughing, gagging, straining
    Show answer

    Answer: D. Prevent coughing, gagging, straining

    Anything that raises intraocular pressure, such as coughing, bucking on the tube, vomiting, or straining, can push eye contents out through a globe wound. Adequate sedation and smooth airway management help; the airway always takes priority over the eye. A firm patch presses on the globe, routine hyperventilation harms the injured brain, and a nasal route adds risk in facial trauma without protecting the eye.

20. Retinal detachment is a medical emergency because:

    1. A. It causes severe, unrelenting pain
    2. B. Vision is saved only by prompt surgery
    3. C. It leads quickly to shock
    4. D. It spreads to the other eye within hours
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    Answer: B. Vision is saved only by prompt surgery

    If the retina stays detached, its cells die from lack of blood supply, and vision is lost permanently. The condition is painless, which leads some patients to delay care.

21. When documenting vision in an eye-injured patient who cannot read any letters, the next step down in testing is to check whether he can:

    1. A. Count your fingers, then see hand motion
    2. B. Read a phone screen at one foot away
    3. C. Identify colors on a chart at a distance
    4. D. Describe the shape of the room's lights
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    Answer: A. Count your fingers, then see hand motion

    If a patient cannot read print, vision is recorded in descending order as counting fingers (at a stated distance), seeing hand motion, perceiving light, or no light perception. This gives the receiving team a baseline. Reading a phone screen is a print test he has already failed, and color or room-light descriptions are not standard measures.

22. A 20-year-old has a severe facial injury, and his eye has been pulled partially out of the socket. You should:

    1. A. Push it gently back into the orbit
    2. B. Leave it exposed so the pupil can be checked
    3. C. Apply direct pressure to control bleeding
    4. D. Cover it with moist gauze and a cup
    Show answer

    Answer: D. Cover it with moist gauze and a cup

    An extruded eye is kept moist and protected under a cup, and both eyes are covered. Attempting to replace it can injure the optic nerve and vessels further.

23. After blunt trauma, a patient has a tense, bulging eye with decreasing vision and severe pain. This most likely indicates:

    1. A. A retrobulbar hematoma
    2. B. An isolated eyelid laceration
    3. C. A subconjunctival hemorrhage
    4. D. Ultraviolet keratitis
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    Answer: A. A retrobulbar hematoma

    Bleeding behind the globe causes orbital compartment syndrome, compressing the optic nerve and blood supply; vision may be lost within hours without decompression. It is a time-critical transport.

24. An eyelid laceration should be managed by:

    1. A. Applying firm pressure directly over the closed globe
    2. B. Covering it with a moist dressing without pressure
    3. C. Closing it with adhesive strips in the field
    4. D. Irrigating it with tap water at high pressure
    Show answer

    Answer: B. Covering it with a moist dressing without pressure

    Eyelid bleeding can be heavy, but pressure on the globe must be avoided because a globe injury may lie beneath. Closure is done by a physician, sometimes a specialist if the lid margin or tear duct is involved.

25. A 6-year-old has a corneal abrasion from a fingernail. Which finding is expected?

    1. A. Painless loss of vision in one visual field
    2. B. Blood layered in the anterior chamber
    3. C. Severe pain and a foreign body sensation
    4. D. A teardrop-shaped pupil
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    Answer: C. Severe pain and a foreign body sensation

    Corneal abrasions are extremely painful because the cornea is richly innervated, and patients feel a foreign body sensation, tearing, and light sensitivity. A teardrop pupil suggests an open globe.