Wilderness Medical Society Practice Guidelines for Treatment of Eye Injuries and Illnesses in the Wilderness: 2014 Update

Abstract

A panel convened to develop an evidence-based set of guidelines for the recognition and treatment of eye injuries and illnesses that may occur in the wilderness. These guidelines are meant to serve as a tool to help wilderness providers accurately identify and subsequently treat or evacuate for a variety of ophthalmologic complaints. Recommendations are graded on the basis of the quality of their supporting evidence and the balance between risks and benefits according to criteria developed by the American College of Chest Physicians. This is an updated version of the original guidelines published in Wilderness & Environmental Medicine 2012;23(4):325-336.

Research Gaps in Wilderness Medicine

“…A list of all recommendations, corresponding PICO questions, and the number of studies addressing these recommendations is provided in Table 3. 8 ,21,24–33…”

“…The percentage of low-quality evidence recommendations ranged from 16.7 (acute pain) to 96.0% (lightning strikes) (Table 2). 8,21,[24][25][26][27][28][29][30][31][32][33] Search strings for each CPG identified 8899 articles. Of the articles identified, only 33 provided support for 29 individual PICO questions (Table 3).…”

“…A list of all recommendations, corresponding PICO questions, and the number of studies addressing these recommendations is provided in Table 3. 8,21,[24][25][26][27][28][29][30][31][32][33] We attempted to evaluate whether studies located in the trial registries would upgrade the status of a recommendation if they were included as supporting evidence. Table 4 lists the study designs associated with each study.…”

“…Another example of an unresolved research gap is in the treatment of eye injuries, 27 which includes 49 level 1C and 2C recommendations in the guideline ( Table 3). The authors of this CPG had to make recommendations without adequate evidence.…”

“…In the field of wilderness medicine, where no instruction is taking place because of the rarity of certain conditions, environments, or injuries, simulation-based learning may provide a plausible means of instruction. Another example of an unresolved research gap is in the treatment of eye injuries, 27 which includes 49 level 1C and 2C recommendations in the guideline (Table 3). The authors of this CPG had to make recommendations without adequate evidence.…”