ATP 4-02.11 Reference

EYE TRAUMA: TYPES, TREATMENT & EVACUATION

Source: ATP 4-02.11, Chapter 10 — Eye Trauma, 23 March 2026

Key Points

  • NEVER apply pressure to an injured eye
  • Shield both eyes only when both are confirmed/suspected injured
  • For one injured eye: shield only the injured eye — covering the uninjured eye creates a litter casualty unnecessarily
  • Eye shield secured at 45-degree angle across forehead and cheek
  • If no rigid shield: use tactical eyewear as substitute
  • Chemical burns: immediately irrigate with water
  • Detached eyelid pieces: place on clean bandage and send with casualty
  • Eye injuries are secondary (W in MARCH-PAWS)

What NEVER to Do

  • Do NOT apply pressure to injured eye
  • Do NOT remove anything from the eye surface
  • Do NOT put anything on the eye itself (medications, ointments)
  • Do NOT try to push a prolapsed (extruded) eye back into socket
  • Do NOT remove an impaled object from the eye

Examine Eyes For

  • Objects protruding from eyes
  • Foreign objects in or on the eyes
  • Swelling or lacerations
  • Bloodshot appearance of the white of the eyes
  • Bleeding surrounding the eye, inside the eyeball, or from the eyebrow
Critical Warning

Do NOT apply pressure to the injured eye. Do NOT remove anything from the eye surface — this could cause additional harm, such as loss of eyesight or loss of the eye. The eyeball contains fluid; pressure applied over the eye will force the fluid out, resulting in permanent injury. (ATP 4-02.11, paras 10-5 to 10-6)

Eye Injury — Casualty Positioning

Position the casualty before treating: (ATP 4-02.11, para 10-11)

  • Conscious casualty: Seated position
  • Unconscious casualty: Supine position with head slightly elevated
  • Gently clean any dirt or blood from the area around the eye

Types of Eye Injuries and Treatment

Eyelid Laceration

Lacerated or torn eyelids may bleed heavily, but bleeding usually stops quickly.

  • Cover the injured eye with a sterile dressing only — NO pressure on the wound
  • Handle torn eyelids very carefully to prevent further injury
  • If any eyelid tissue is detached: place on a clean bandage or dressing and immediately send with the casualty to the medical facility

Eyeball Laceration

Lacerations or cuts to the eyeball may cause serious and permanent eye damage.

  • Cover with a loose sterile dressing — no pressure
  • Apply a rigid eye shield over the dressing to protect from further trauma
  • Do NOT put anything on the eye itself, especially if you think the eye is cut

Foreign Object in Eye

  • If an object is not penetrating (surface only): gently irrigate with clean water to flush it out — do not rub
  • If an object is embedded or penetrating: do NOT attempt removal. Stabilize the object (if protruding), cover loosely with a rigid eye shield or improvised cup, and evacuate

Eye Extrusion (Prolapsed Globe)

When the eyeball has been displaced from its socket:

  • Do NOT attempt to push the eye back into the socket
  • Moisten a clean dressing and place it gently over the eye to keep it moist
  • Apply a rigid eye shield or improvised cup over the dressing without touching the eye
  • Evacuate as a priority casualty

Chemical Burns of the Eye

  • Immediately irrigate the eye with large amounts of clean water — this is time-critical
  • Flush from inner corner to outer corner; keep flushing for at least 15 minutes
  • Remove contact lenses if present before or during irrigation
  • After irrigation: cover with sterile dressing and rigid eye shield
  • Evacuate to medical facility

Rigid Eye Shield Application

  1. 1

    Do NOT apply pressure to the eye. Place a sterile dressing loosely over the injured eye if needed.

  2. 2

    Position the rigid eye shield over the injured eye. The shield's rim should rest on the bony orbit (the brow and cheekbone) — not on the eyeball or eyelid.

  3. 3

    Secure the shield with tape at a 45-degree angle across the forehead and cheek.

  4. 4

    Shield both eyes only when you are sure or strongly suspect that both eyes have been injured. Unnecessarily shielding both eyes makes an ambulatory casualty a litter casualty. (ATP 4-02.11, para 10-7)

ATP 4-02.11 Source

Chapter 10: Eye Trauma — Army Techniques Publication 4-02.11, Casualty Response, Tactical Combat Casualty Care, and First Aid. Headquarters, Department of the Army, 23 March 2026.

See It in Practice — ESB Tasks

These ESB Medical Lane tasks apply this doctrine directly:

M9: Abdominal Wound & Eye Injuries
Secondary Assessment Head Injury & TBI