Managing penetrating eye injuries in tactical care: rapid visual acuity testing, a rigid eye shield, and CWMP

Penetrating eye injuries in the heat of combat are the kind of problem that makes your pulse quicken and your math blur a little. But here’s the reassuring truth: with a clear, simple protocol you can stabilize the eye and protect vision long enough to get the patient to higher care. The core steps—rapid visual acuity testing, covering with a rigid eye shield, and following the Combat Wound Management Protocol (CWMP)—come up again and again in Tactical Combat Casualty Care for good reason. They’re practical, reliable, and designed for the chaos of the field.

Let me explain why this trio matters so much, and how it actually plays out in the moment.

What makes penetrating eye injuries so tricky?

The eye is small, delicate, and connected to the body by nerves and blood vessels. A wound there can signal deeper trouble in a heartbeat. A penetrating injury might not look dramatic at first glance, yet the damage can affect vision permanently if not managed carefully. In a tactical setting, you’re also juggling movement, exposure, and the risk of further injury from shrapnel, debris, or equipment shifting. The instinct to “do something fast” can be strong, but the best care follows a controlled sequence that both preserves eye structure and keeps the casualty stable.

The proper protocol (the three essentials in order)

1. Rapid visual acuity test (RVAT)

Here’s the thing about eye injuries: you can’t treat what you can’t quantify. A quick visual acuity test gives you a snapshot of how the eye is functioning and helps guide decisions. In the field, you don’t need a fancy chart. If the patient can read a chart, great. If not, you still assess their ability to count fingers, detect hand movements, or perceive light. Record what you observe as soon as you can. This test isn’t the final verdict, but it’s the map that tells you whether the eye is preserving function or slipping toward a more serious threat.

Why do it first? Because every action you take afterward should be measured against how much vision remains and what that implies for evacuation priorities. A rapid check now can prevent you from over- or under-treating, and it gives the medical team a baseline when you hand off care.

2. Cover with a rigid eye shield

After you’ve done the RVAT, protect the eye with a rigid shield. The shield acts like a tiny, sturdy shell around the globe—stabilizing the eye and preventing painful movement or unintended contact with the wound. This is crucial in a dynamic environment where jostling, wind, or dust could aggravate the injury.

A rigid shield keeps pressure off the wound and reduces the risk of secondary damage from rubbing or contact with debris. If you don’t have a purpose-made eye shield handy, you can improvise with a rigid, clean barrier that sits over the eye without pressing on it. The main idea is clear: don’t leave the eye exposed to movement or external forces.

3. CWMP — Combat Wound Management Protocol

CWMP is the broader framework that ties this eye care into overall casualty management. It’s not just about one eye; it’s about keeping the casualty stable while you move toward definitive care. In practice, CWMP means:

• Maintain airway, breathing, and circulation. Check for signs of trouble with ventilation or trouble with bleeding elsewhere, and manage accordingly.

• Control bleeding and prevent shock. Treat obvious bleeding, keep the person warm, and monitor mental status and vitals.

• Protect the injury while you arrange evacuation. The rigid shield stays in place; avoid removing any object that may be embedded unless a trained professional tells you to do so.

• Monitor and reassess. Re-check the eye’s appearance, pupil response (to the extent possible), and the patient’s overall condition at regular intervals.

• Coordinate evacuation. Get the casualty to higher care as quickly as possible, sharing your RVAT results and the status of the eye with the receiving team.

Put simply: RVAT tells you where you’re starting, the shield buys you time and safety, and CWMP ensures you’re not losing sight of the bigger picture as you move toward definitive care.

Why the other options aren’t the right fit for penetrating eye injuries

• A. Apply a light bandage and send for help

A light bandage is too flimsy to stabilize a penetrating eye injury. It may protect briefly, but it won’t prevent movement or extra insult to the eye. You want something rigid that limits motion and shields the organ from further harm. So this falls short of the need.

• C. Flush the eye with saline and cover it

Flushing can be essential for certain chemical exposures, but for penetrating injuries, irrigation isn’t the default move. It risks pushing debris deeper or causing more tissue disruption if the object isn’t stabilized. Covering with a rigid shield is the safer, more protective step first, and any irrigation should be guided by medical command depending on the situation.

• D. Remove any foreign objects and apply a patch

This is a red flag in the field. If a foreign object remains embedded, attempting removal without proper tools and training can worsen the injury or damage nearby structures. Rely on stabilization and rapid evacuation instead. Once in a controlled medical setting, trained professionals can decide whether removal is appropriate.

Practical tips for applying the protocol in real life

• Keep it simple and deliberate. In the heat of the moment, a calm, repeatable routine helps. RVAT, shield, CWMP—do them in that order, and narrate your actions in short phrases so your teammate knows what’s happening.

• Use whatever rigid shield you can. A purpose-built eye shield is ideal, but in a pinch a clean, rigid barrier that does not press on the eye will do. The goal is to prevent movement and further harm.

• Don’t remove embedded objects. If something is lodged in the eye, leave it in place and secure the area around it. Advise medical personnel about the object’s size, shape, and entry/exit points if you can.

• Mind the environment. In dusty or windy conditions, the shield also doubles as a dust barrier, helping reduce contamination of the wound.

• Communicate clearly. When you pass the patient to a medic or evacuate, share the RVAT findings, the presence of a shield, and any concerns about the eye health. Consistent hand-off saves precious minutes.

Real-world practice notes

• Training matters. Drills that include eye injuries help you internalize the sequence so it becomes second nature, even under stress. Regular repetition builds muscle memory—like a rhythm that keeps your team synchronized.

• PPE and readiness. Eye protection isn’t just for show. Beyond the shield, ensure you have clean gloves, sterile or clean dressings, and a means to secure the shield and surrounding materials without causing tape or fabric to pull on the eye region.

• The bigger picture. Eye injuries rarely stay isolated. You’re balancing the risk of vision loss with other injuries that may demand attention. The CWMP framework helps you integrate eye care into comprehensive casualty management, which is how you save more lives on the ground.

A quick mental model you can carry

• RVAT first: establish function fast.

• Shield second: protect the eye from movement and external factors.

• CWMP third: safeguard the casualty as you orchestrate transport and advanced care.

Think of it like stabilizing a fragile, precious instrument before packing it away for expert repair. The field is rough, but the goal is precise.

Subtle nods to related tensions and how this protocol fits into the bigger picture

In combat medicine, you’ll hear a lot about speed, but speed without direction isn’t helpful. The eye isn’t a stand-alone issue; it sits in the context of breathing, circulation, and the body’s overall response to injury. The RVAT gives you a window into function, the rigid shield buys you time, and CWMP ensures you don’t lose sight of the whole person while waiting for advanced care. It’s a disciplined balance between care in the moment and the realities of transport, the terrain, and the patient’s evolving condition.

A few practical examples to anchor the concept

• Example 1: A soldier sustains a penetrating injury from shrapnel in a dusty field. You perform a quick visual check—slightly reduced acuity but some light perception. You place a rigid shield, stabilize the head, and initiate CWMP while arranging rapid evacuation. The eye is protected, and you’ve kept the patient stable for what comes next.

• Example 2: An improvised encounter where the shield isn’t perfect, but you still block movement and avoid removing any object. You remember to monitor vitals, maintain warmth, and coordinate transport. The key is that you didn’t gamble with the wound by rushing into irrigation or object removal.

Final takeaway

A penetrating eye injury is serious business, but it’s also a scenario where a clear, simple protocol makes a big difference. Rapid visual acuity testing sets the baseline. A rigid eye shield prevents movement and further harm. The CWMP framework ties everything together, ensuring the casualty remains stable and ready for definitive care. In the field, that combination is a practical, reliable path through uncertainty toward better outcomes.

If you’re training with this in mind, keep a mental checklist handy and practice the sequence with partners. The eye deserves nothing less than deliberate care, and in the right hands, that care can preserve vision and save lives.

Quick reference recap

• Do RVAT first to gauge eye function.

• Apply a rigid eye shield to stabilize the eye.

• Follow CWMP to manage the casualty and arrange rapid evacuation.

• Avoid removing embedded objects and avoid unnecessary irrigation in penetrating injuries.

• Integrate eye care into overall casualty management to maximize outcomes.