Head, Neck & Eye Injuries

Head, neck, and eye injuries are among the most serious and nuanced injuries a first-aider can face. A concussion looks different from a skull fracture, and both look different from a catastrophic bleed inside the skull. A spinal cord injury may produce no external signs at all. A penetrating eye injury requires completely different management from a blunt one. The stakes are high: the wrong action — particularly moving a spinal injury victim incorrectly, or removing a penetrating object from an eye — can cause catastrophic, irreversible harm.

This guide provides the key assessment skills and treatment principles for these injury categories.

Head Injuries — Overview

Head injuries range from minor scalp lacerations to life-threatening intracranial haemorrhage. The most important principle in head injury assessment is that things can change. A person who appears fine immediately after a head injury may deteriorate over hours as bleeding expands inside the skull.

Concussion (Mild Traumatic Brain Injury)

Concussion is a temporary disruption of brain function following a head impact, without structural brain damage visible on imaging.

Signs and symptoms:

• Brief loss of consciousness (or none at all)
• Confusion, disorientation, "fogginess" — does not know where they are, what happened
• Amnesia — cannot remember the impact event or the period before/after
• Headache
• Dizziness or balance problems
• Nausea or vomiting
• Sensitivity to light or noise
• Visual disturbances (blurring, double vision)
• Feeling slowed down

Management of concussion:

1. Remove the person from the activity immediately — returning to play or activity while concussed risks second impact syndrome (catastrophic brain swelling from a second concussion before the first has resolved)
2. Assess for more serious injury (see red flags below)
3. Rest physically and cognitively — no screens, no reading, no demanding mental tasks initially
4. Do not give NSAIDs (aspirin, ibuprofen) in the acute period — these increase bleeding risk
5. Paracetamol/acetaminophen is acceptable for headache
6. Medical evaluation should follow

⚠️ "They were only out for a few seconds" does not mean the injury is minor. Any loss of consciousness or significant confusion after a head impact requires medical evaluation.

Red Flags — Serious or Deteriorating Head Injury

Any of the following after a head injury demands immediate emergency services:

Red Flag	Possible Significance
Seizure after the impact	Significant brain injury
Repeated or forceful vomiting	Raised intracranial pressure
Unequal pupils	Expanding intracranial bleed
Rapidly worsening headache	Raised intracranial pressure
Weakness or numbness in limbs	Brain or spinal cord injury
Clear fluid from nose or ears	Cerebrospinal fluid leak — skull base fracture
Bruising behind the ears (Battle's sign)	Skull base fracture (appears hours after injury)
Bruising around both eyes (raccoon eyes)	Skull base fracture (appears hours after injury)
Deteriorating consciousness or confusion	Expanding intracranial bleed
Loss of consciousness longer than a few minutes	Significant brain injury

Skull Fractures

A skull fracture itself is not always the primary concern — the associated intracranial injury is. Signs that may suggest a skull fracture:

• Obvious deformity or depression of the skull on palpation
• Clear fluid (watery/slightly yellowish) from nose or ears
• Bruising around eyes or behind ears (may not appear for hours)
• Step or gap felt in the skull

Management: Call emergency services. Do not apply direct pressure to a suspected skull fracture site — you may push bone into the brain. Dress any wound with a clean dressing without compressing the fracture. Monitor consciousness level closely.

Spinal Injury Assessment

The cervical spine (neck) is most vulnerable in high-energy trauma.

Suspect spinal injury when:

• High-energy mechanism: vehicle collision, fall from height, diving accident, sports impact, blast
• Neck or back pain after trauma
• Tingling, numbness, or weakness in arms, legs, or torso
• Unconsciousness with unknown mechanism

Examination clues:

• Point tenderness along the spine (press on each vertebra)
• Motor and sensory function in all four limbs
• Paradoxical breathing pattern (the chest moves instead of the abdomen — suggests high spinal injury affecting diaphragm control)

Management when spinal injury is suspected:

1. Keep the person still — do not allow unnecessary movement
2. Maintain the head in the neutral position — gentle inline stabilisation by one person holding the head in line with the body
3. Call emergency services — specialist immobilisation equipment (cervical collar, spinal board) should be used
4. Do not move the person unless life safety demands it (fire, flooding, no breathing)

If the person is unconscious and not breathing: Airway and CPR take absolute priority. Move the person carefully if needed, maintaining as much inline stabilisation as possible, but do not delay CPR for concerns about spinal injury.

Eye Injuries

The eye is a delicate organ that is easily damaged and has limited ability to repair itself. Early and correct management of eye injuries significantly affects long-term vision outcomes.

Blunt Eye Trauma

Impact without penetration — from fists, sports equipment, projectiles that do not penetrate.

Signs:

• Pain and tenderness around the eye
• Periorbital swelling (black eye)
• Subconjunctival haemorrhage (red blood visible in the white of the eye) — usually benign
• Visual disturbance — blurred or reduced vision, double vision

Concerning signs needing immediate medical attention:

• Irregular pupil shape (may indicate globe rupture)
• Significantly reduced vision
• Persistent double vision
• Visible deformity of the eye itself
• Restricted eye movement (orbital fracture can trap eye muscles)

Management:

• Apply a cold compress (not ice directly on eye) to reduce swelling
• Do not press on the eye
• Seek medical evaluation for any significant blunt eye trauma

Penetrating Eye Injuries

A penetrating object in the eye is an ocular emergency. Examples: glass, metal fragments, wire, projectiles.

⚠️ Never remove an object penetrating the eye. The object may be plugging a hole in the globe — removing it can allow vitreous fluid to escape and cause permanent blindness. This is a strict rule.

Management:

1. Do not remove the object
2. Do not press on the eye or allow the person to rub it
3. Stabilise the object if possible — cup a disposable cup or cone of cardboard gently over the eye to protect without pressure, and tape it in place
4. Cover the uninjured eye — movement of the uninjured eye causes sympathetic movement of the injured eye (consensual eye movement), which can worsen injury
5. Keep the person calm and still; lay them down if possible
6. Call emergency services; transport to an eye hospital

Chemical Eye Burns

Chemical splashes to the eye require immediate irrigation regardless of the chemical:

1. Irrigate immediately with clean water or saline — hold the eyelid open and flush continuously for at least 20 minutes
2. Remove contact lenses if present and possible
3. Do not patch the eye after irrigation
4. Seek immediate ophthalmology care — some chemicals (particularly alkalis) continue to penetrate even after washing

Foreign Bodies (Non-Penetrating)

A small particle on the surface of the eye:

1. Do not rub the eye — rubbing can scratch the cornea
2. Try blinking repeatedly — tears may wash the particle out
3. Gentle irrigation with clean water or saline
4. If visible under the upper lid, pull the upper lid gently outward and downward over the lower lid to expose it and encourage the lower lashes to sweep it away
5. Do not attempt to remove a particle directly from the corneal surface with a finger or cotton bud — refer to a healthcare provider for this

Quick Reference

Injury	Action
Concussion suspected	Remove from activity; rest; medical evaluation; no NSAIDs
Red flags present	Emergency services immediately
Skull fracture suspected	No pressure on site; clean dressing; emergency services
Suspected spinal injury	Keep still; inline stabilisation; emergency services
Spinal + no breathing	CPR priority; maintain stabilisation during move
Blunt eye trauma	Cold compress; no pressure; medical evaluation
Penetrating eye object	Do not remove; cup to protect; cover other eye; emergency services
Chemical eye burn	Irrigate 20+ min immediately; ophthalmology
Surface foreign body	Blink/irrigate; do not probe

This guide provides general first-aid information for head, neck, and eye injuries. Head and eye injuries should be assessed by medical professionals. Any deterioration in consciousness after a head injury, or any suspected penetrating eye injury, is a medical emergency.