EM · Procedural & diagnostic ED skills
Eye, ENT and dental procedures in the emergency department
Also known as Ocular irrigation · Slit-lamp examination · Tonometry · Corneal foreign body removal · Nasal packing for epistaxis · Nasal foreign body removal · Dental avulsion replantation · Dry socket management
The ED eye, ENT and dental procedures cluster — slit-lamp and fluorescein for the corneal abrasion, tonometry for the angle-closure screen, rust-ring debridement, copious irrigation for the chemical burn (Morgan lens, pH-driven), epistaxis by cautery and packing with tranexamic-acid adjunct, nasal foreign-body extraction starting with positive pressure, the avulsed permanent tooth replanted promptly, and the dry socket irrigated and dressed. Fellowship techniques with evidence-bound indications and contraindications.
Checked against its sources on 13 Oct 2026
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Target exams
Red flags
- Chemical eye injury is time-critical — start copious irrigation immediately, BEFORE history and slit-lamp; check the pH and irrigate until neutral
- Never applanate or press on a globe with a suspected rupture or an intraocular foreign body — confirm the globe is intact first
- A button battery in the nose or ear is an emergency — remove urgently, with referral if it cannot be retrieved
- Reimplant only permanent teeth — primary (deciduous) teeth are NOT reimplanted
- A posterior nasal pack needs admission and monitoring — the elderly and the comorbid tolerate airway compromise worst
Meet the patient
A toddler is wheeled into resus screaming, the right eye clamped shut after a drain-cleaner splash. The registrar reaches for the slit-lamp and the visual-acuity chart.[2]
Stop. Eye irrigation must be instituted immediately at the scene of exposure and continued in the emergency department — the slit-lamp waits; the irrigation does not. Alkali agents are lipophilic and penetrate rapidly by saponifying cell membrane lipids, causing liquefactive necrosis; acid coagulates a protein barrier that limits depth.[2][1]
References20ShowHide
- [1]Patek GC, Bates A, Gurnani B Ocular Burns. StatPearls, 2026.PMID 29083604
- [2]Ramponi DR. Chemical Burns of the Eye Adv Emerg Nurs J, 2017.PMID 28759511
- [3]Liston RL, Olson RJ, Mamalis N, et al. A comparison of rust-ring removal methods in a rabbit model: small-gauge hypodermic needle versus electric drill Ann Ophthalmol, 1991.PMID 2012370
- [4]Patterson J, Fetzer D, Krall J, et al. Eye patch treatment for the pain of corneal abrasion South Med J, 1996.PMID 8578357
- [5]Chan PP, Zhang X, Aung T, et al. Controversies, consensuses, and guidelines for acute primary angle closure attack (APACA) by the Asia-Pacific Glaucoma Society (APGS) and the Academy of Asia-Pacific Professors of Ophthalmology (AAPPO) Asia Pac J Ophthalmol (Phila), 2025.PMID 40615047
- [6]Lane Wilson J Foreign Bodies in the Ear, Nose, and Throat Am Fam Physician, 2025.PMID 40736491
- [7]Bourguignon C, Cohenca N, Lauridsen E, et al. International Association of Dental Traumatology guidelines for the management of traumatic dental injuries: 1. Fractures and luxations Dent Traumatol, 2020.PMID 32475015
- [8]Levin L, Day PF, Hicks L, et al. International Association of Dental Traumatology guidelines for the management of traumatic dental injuries: General introduction Dent Traumatol, 2020.PMID 32472740
- [9]Fouad AF, Abbott PV, Tsilingaridis G, et al. International Association of Dental Traumatology guidelines for the management of traumatic dental injuries: 2. Avulsion of permanent teeth Dent Traumatol, 2020.PMID 32460393
- [10]Fatahi M, Aghajani S, Samadi Y, et al. A meta-analysis on the efficacy of topical tranexamic acid for epistaxis: Does the method of administration affect the success rate? Australas Emerg Care, 2026.PMID 42297643
- [11]Boldes T, Zahalka N, Kassem F, et al. Epistaxis first-aid: a multi-center knowledge assessment study among medical workers Eur Arch Otorhinolaryngol, 2024.PMID 38748311
- [12]Siriwattanadom S, Kheawfu K, Laosuwan K, et al. An Update on Herbal Remedies for Treatment of Alveolar Osteitis: A Narrative Review Eur J Dent, 2026.PMID 41558540
- [13]Randall DA. Epistaxis packing. Practical pointers for nosebleed control Postgrad Med, 2006.PMID 16913650
- [14]Abraham ZS, Fussi OC, Kahinga AA. Knowledge and practices of epistaxis in Eastern Tanzania: a cross-sectional study of an emergency in otorhinolaryngology Afr J Emerg Med, 2024.PMID 38545448
- [15]Cooper CM, Berg E, Ashurst J. Scratching the surface: re-evaluating the management of corneal abrasions Cureus, 2026.PMID 41835781
- [16]Spowart E, Pradhan S, Bruce C, et al. Outcomes in acute ocular surface chemical injury-role of pH measurement on presentation: a retrospective cohort study Ophthalmol Ther, 2025.PMID 40459810
- [17]Pizzorno A, Friedrich L, Tavares V. [Eye injuries caused by chemical burns: measure the pH] Rev Med Suisse, 2025.PMID 40566810
- [18]Thoyalil M, Belchada DK, Bidya Devi K, et al. The comparative analysis of the effectiveness of four different storage media (Placentrex, Propolis 10%, Pomegranate Juice 5%, and Hank's balanced salt solution) in preserving the viability of periodontal ligament cells: an in vitro study Cureus, 2023.PMID 37671229
- [19]Daly BJ, Sharif MO, Jones K, et al. Local interventions for the management of alveolar osteitis (dry socket) Cochrane Database Syst Rev, 2022.PMID 36156769
- [20]Royal Children's Hospital Melbourne Clinical Practice Guideline: Dental injuries RCH clinical guideline (web), 2024.Source