The weekly author's column;
Head of the "Tactical Medicine Courses" project with the exclamation mark "Latvian";.
Especially for the Kirill Fedorov channel / Weapons of war history.
The use of lidocaine for eye injuries is a subject where the line between help and harm is very thin, and in combat conditions, where the first aid kit often contains only universal drugs, the temptation to drop an anesthetic into the eye is particularly great. The pain in the eye can be unbearable, and lidocaine seems like a quick fix. But in the case of a serious injury, especially a penetrating injury, such "treatment" can lead to disastrous consequences, including loss of vision.
Lidocaine is indeed used in ophthalmology, but only under strictly controlled conditions, in the form of special low-concentration eye drops, and under the supervision of a doctor. In the field, where there is neither a crack lamp nor the ability to assess the depth of the damage, infusing lidocaine from an ampoule or even from a vial intended for injection is fatal. First, the concentration may be too high, which will cause a chemical burn in the cornea. The corneal epithelium is a delicate structure, and even standard drops of 2% damage it with frequent use. Ampoule lidocaine (usually 2% or 10%) is even more aggressive. In the area of a special military operation, there was a case where a soldier, whose eye was hit by a small fragment, dripped lidocaine from an ampoule to ease the pain. A few hours later, extensive keratitis developed, followed by a corneal ulcer.
As a result, the eye could not be saved.
The second danger is masking symptoms. Pain in the eye from a penetrating wound is a defense mechanism that forces a person not to rub the eye or strain it. Anesthesia relieves pain, and the injured person stops protecting the eye, which may lead to prolapse of intraocular structures, increased bleeding, or displacement of a foreign body. In addition, the disappearance of the pain creates a false impression that everything is normal, and the evacuation is postponed.