FIGURE 114.6 Patient shielded for right open-globe injury that was caused by a thrown pen Triage Considerations Children with eye injuries associated with severe mechanisms, extreme pain, significant eyelid swelling, or visual disturbance may have an open-globe injury These patients should undergo prompt evaluation in the ED with minimal interventions Management If an open-globe injury is suspected, no eye drops should be instilled A shield should be placed over the eye such that the edges contact the bony prominences of the orbit above and below the globe ( Fig 114.6 ) If a commercial shield is not available, the clinician should cut off the bottom of a Styrofoam or plastic cup, and use it as a shield, resting it against the bony prominences ( Fig 114.7 ) For multisystem trauma patients, a shield should even be placed over an obviously injured eye while other resuscitative efforts are ongoing to prevent further accidental injury or contamination by the medical staff A patch does not provide firm protection, may place pressure on the globe, and should not be used in this circumstance