Eye Injuries

Eye Injuries Overview

Eye injuries can range from the very minor, such as getting soap in your eye, to the catastrophic, resulting in permanent loss of vision or loss of the eye. They often occur in the workplace, at home, in other accidents, or while participating in sports.

Eye Injuries Causes

    Chemical exposures and burns: A chemical burn can occur in a number of ways but is most often the result of a liquid splashing into the eye. Many chemicals, such as soap, sunscreen, and even tear gas, are primarily irritants to the eye and do not usually cause permanent damage. However, acids and alkalis are highly caustic and may cause severe and permanent damage to the ocular surface.
        Acids (such as sulfuric acid found in car batteries) or alkalis (such as lye found in drain cleaner and ammonia) can splash into the eyes.
        Rubbing the eye can transfer chemicals from the skin on the hands to the eye.
        Aerosol exposure is another method of potential chemical injury and includes such substances as Mace, tear gas, pepper spray, or hairspray.
    Subconjunctival hemorrhage (bleeding): This is blood lying on the surface of the white of the eye (sclera). It is contained by the conjunctiva, which is the membrane that lies over the sclera. Subconjunctival hemorrhage may accompany any nonchemical eye injury. The degree of subconjunctival hemorrhage is not necessarily related to the severity of the injury.
    Corneal abrasions: The cornea is the transparent tissue that is located in front of the pupil and iris. A corneal abrasion is a scratch or a traumatic defect in the surface of the cornea. People with corneal abrasions often report that they were "poked" in the eye by a toy, a metallic object, a toddler's fingernail, or a tree branch.
    Traumatic iritis: This type of injury can occur in the same way as a corneal abrasion but is more often a result of a blunt blow to the eye, such as from a fist a club, or an air bag in a car. The iris is the colored part of the eye. It is actually a muscle that controls the amount of light that enters the eye through the pupil. Iritis simply means that the iris is inflamed.
    Hyphemas and orbital blowout fractures: These injuries are associated with significant force from a blunt object to the eye and surrounding structures. Examples would be getting hit in the face with a baseball or getting kicked in the face.
        Hyphemas are the result of bleeding in the eye that occurs in the front part of the eye, called the anterior chamber. This is the space between the cornea and the iris. The anterior chamber is normally filled with clear fluid, called the aqueous fluid.
        Orbital blowout fractures are breaks of the facial bones surrounding the eye.
        Lacerations (cuts) to the eyelids or conjunctiva (the clear covering over the white of the eye). These injuries commonly occur from sharp objects but can also occur from a fall.
        Lacerations to the cornea and the sclera: These injuries are very serious and are frequently associated with trauma from sharp objects.
        Foreign bodies in the eye: Generally, a foreign body is a small piece of metal, wood, or plastic filing.
            Corneal foreign bodies are embedded in the cornea and have not penetrated the eye itself. Iron containing metal foreign bodies in the cornea can cause a rusty stain in the cornea, which also requires treatment.
            Intraorbital foreign bodies are in the orbit (or eye socket) but have not penetrated the eye.
            Intraocular foreign bodies are injuries in which the outer wall of the eye has been penetrated by the object.
            Ultraviolet keratitis (or corneal flash burn): The most common light-induced trauma to the eye is ultraviolet keratitis, which can be thought of as a sunburn to the cornea. Common sources of damaging ultraviolet (UV) light are arc welders, tanning booths, and the sun, especially at higher altitudes where UV rays are more intense or by light reflected by snow or water.
            Solar retinopathy: Damage to the central part of the retina can occur by staring at the sun. Common situations that may cause this are viewing solar eclipses or drug-induced extended looking at the sun.




Eye Injuries Symptoms and Signs

    Chemical exposure: The most common symptoms are pain or intense burning. The eye will begin to tear profusely, may become red, and the eyelids may become swollen.
    Subconjunctival hemorrhage (bleeding): Generally, this condition by itself is painless. Vision is not affected. The eye will have a red spot of blood on the sclera (the white part of the eye). This occurs when there is a rupture of a small blood vessel on the surface of the eye. The area of redness may be fairly large, and its appearance is sometimes alarming. Spontaneous subconjunctival hemorrhages may occur in the absence of any known trauma. If it unassociated with other signs of trauma, it is not dangerous and generally goes away slowly with no treatment.
    Corneal abrasions: Symptoms include pain, a sensation that something is in the eye, tearing, and sensitivity to light.
    Iritis: Pain and light sensitivity are common. The pain may be described as a deep ache in and around the eye. Sometimes, excessive tearing is seen.
    Hyphema: Pain and blurred vision are the main symptoms.
    Orbital blowout fracture: Symptoms include pain, especially with movement of the eyes; double vision that disappears when one eye is covered; and eyelid swelling which may worsen after nose blowing. Swelling around the eye and bruising often occur. A black eye is the result of blood pooling in the eyelids. This can take weeks to disappear totally.
    Conjunctival lacerations: Symptoms include pain, redness, and a sensation that something is in the eye.
    Lacerations to the cornea and the sclera: Symptoms include decreased vision and pain.
    Foreign bodies
        Corneal: A sensation that something is in the eye, tearing, blurred vision, and light sensitivity are all common symptoms. Sometimes, the foreign body can be seen on the cornea. If the foreign body is metal, a rust ring or rust stain can occur.
        Intraorbital: Symptoms, such as decreased vision, pain, and double vision, usually develop hours to days after the injury. Sometimes, no symptoms develop.
        Intraocular: People may have eye pain and decreased vision, but, initially, if the foreign body is small and was introduced into the eye at high velocity, people may have no symptoms.
    Light-induced injuries
        Ultraviolet keratitis: Symptoms include pain, light sensitivity, redness, and a feeling that something is in the eye. Symptoms do not appear immediately after ultraviolet exposure but rather about four hours later.
        Solar retinopathy: Decreased vision with a small area of central blurring is the primary symptom.



When to Seek Medical Care

In most cases, if a person has continuing symptoms of pain, visual disturbance, abnormal appearance of the eye or bleeding, they should go to an ophthalmologist (a medical doctor who specializes in eye care and eye surgery). A diagnosis and treatment plan can then be reached.

In general, if a person is not sure if they have a serious eye injury, they should call an ophthalmologist for advice. In the event of eye injury to children, especially infants or toddlers, an examination should be performed.

An ophthalmologist may be helpful in the following circumstances:

    Chemical exposures: If people are not sure if the exposure is potentially serious, they have washed out their eye (preferably at an eye-wash station if they are at work), and if they continue to have symptoms, then the ophthalmologist may be able to help them decide whether or not they should be seen immediately.
    Subconjunctival hemorrhage: If individuals are not sure that they have this condition, your ophthalmologist may be able to help with the diagnosis. This condition, by itself, does not require immediate medical attention.

Continuing pain and decreased vision after an eye injury can be warning signs that require prompt medical attention. If the person has an ophthalmologist, he or she may be able to take care of the patient in their office. Otherwise, go to a hospital's emergency department, preferably in a large hospital where an ophthalmologist is probably on call.

The following conditions should be seen promptly by an ophthalmologist or in the emergency department:

    Chemical exposures: If the substance was known to be caustic, immediate medical evaluation by either an ophthalmologist or in the emergency department is needed, regardless of symptoms. Acids and alkalis are the worst and require immediate attention. If the substance is not dangerous, such as soap or suntan lotion, a visit to the emergency department is not necessary, but a visit to the ophthalmologist's office may be helpful to alleviate any remaining symptoms. When in doubt, seek medical attention.
    Lacerations: Cuts that affect the eyelid margins (where the eyelashes are) or the eyeball itself need immediate medical attention.
    Foreign bodies that are not removed with gentle washing should be evaluated by an ophthalmologist.
    Solar retinopathy: Evaluation by an ophthalmologist is necessary. This is one condition where there is little that can be done in the emergency department.




Questions to Ask the Doctor

    Is there any sign of damage to the eye?
    Is there any sign of permanent vision loss?


Diagnosis of Eye Injuries

As with any medical condition, the history is very important. How the injury occurred will often help the ophthalmologist focus the examination. A patient's vision (visual acuity) will be checked, so patients should bring their glasses to the office visit. The ophthalmologist is interested in preserving the best vision that a individual's eye(s) can achieve.

    To check for injuries to the cornea, the ophthalmologist or emergency medicine doctor usually uses a drop of special dye or stain into the tear-lubricated area that normally lubricates the eye. The dye is called fluorescein, which stains those areas of the cornea that have been damaged. When a blue light is shone over the eye, corneal abrasions turn green.
    A device called a slit lamp is often used as well. A slit lamp is essentially a special magnifying and illuminating microscope to look more closely at the eye.
    X-rays are rarely used, except if an orbital fracture, intraocular, or intraorbital foreign body is suspected. Corneal foreign bodies do not require X-rays.


Eye Injuries Treatment

Self-Care at Home

    Chemical exposures: The single most important thing to do for chemical exposures is to perform first aid by immediately washing out the eye with great amounts of water. Although saline solution is best, regular tap water is a perfectly acceptable alternative. Particularly, for more serious burning materials, such as acid or alkali, time is of the essence. The affected eye should be washed for 20 minutes or more. It is important that people keep their eyelids open during the irrigation process.
        How to wash out the eye: How it is done is less important than getting it done with great amounts of water.
            A water fountain makes a great eye wash. Just lean over the fountain, turn on the water, and keep the exposed eye open.
            At a sink, stand over the sink, cup your hands, and put your face into the running water.
            If a person is near a shower, they should get in and put the exposed eye under the running water. This is a good option if a person has been sprayed with a chemical in the face and hair.
            Hold a glass of water firmly against the orbital bones with the eye open and then tip the head back. Do this many times.
            If a patient is working outside, a garden hose running at a very modest flow will work to flush the eye.
    Subconjunctival hemorrhage: Minimal treatment is needed, if unaccompanied by any other eye injury. Avoid further trauma to the eye, such as rubbing. This injury will heal with time.
    Corneal abrasions: Little can be done at home for corneal abrasions. People who wear contact lenses should avoid using their lenses if they get corneal abrasions until evaluated by an ophthalmologist. Such people should seek medical care promptly.
    Traumatic iritis: Some people become very light sensitive, and sunglasses may help until treatment is begun.
    Hyphema: Keep the head elevated. Do not lie flat. Keep quiet with minimal activity until seen by an ophthalmologist. Do not take aspirin for any pain, because this will increase the risk of bleeding. Seek medical care promptly.
    Orbital blowout fractures: Keep the head elevated, and apply ice to the face to reduce swelling. Do not take aspirin for any pain, because this will increase the risk of bleeding.
    Lid lacerations: Seek immediate medical care. Do not attempt to put anything directly on the eyeball. Do not take aspirin for any pain, because this will increase the risk of bleeding.
    Lacerations to the eyeball: Protect the eye, but do not put any pressure on the eye to avoid further injury. Seek immediate medical attention.
    Foreign bodies: Gentle flushing with water will often dislodge foreign bodies that have not embedded themselves in the cornea. Do not try to rub or wipe off foreign bodies with a tissue, a Q-Tip, or anything else. Doing so will usually not remove an embedded foreign object and will result in a corneal abrasion that may be more painful than the foreign body itself. Intraocular and intraorbital foreign bodies cannot be treated at home.


Medical Treatment

    Chemical exposure: Even if the eye was irrigated at home, the ophthalmologist will probably have the eye irrigated again. The chemical involved and severity of the injury will dictate the treatment. For severe exposures, such as acid or alkali, the pupil may be dilated with special eyedrops, and pain medicine may be prescribed.
    Subconjunctival hemorrhage: Treatment consists of reassurance, avoidance of rubbing the eye, and time.
    Corneal abrasions
        Numbing eyedrops are often used to help examine the eye. Although medicated eyedrops removes the pain, they cannot be used at home to control pain. The anesthetic drops actually delay healing. Repeated use will damage the cornea. Dilating the pupil with drops and antibiotic ointments or drops is a commonly utilized technique.
        Depending on the ophthalmologist, an eyepatch may be used. Some ophthalmologists believe that the patch provides symptomatic relief and speeds healing. Others believe that the increased risk of infection with a patch, particularly in people who wear contact lenses, outweighs the potential benefits.
    Traumatic iritis: Eyedrops are used to dilate the pupil. Steroid eyedrops may be helpful to decrease inflammation.
    Hyphema: People with significant hyphemas may be hospitalized and placed on bed rest with their head elevated. A protective rigid shield may be placed over the eye, and the pupil is dilated with drops. People who will follow the ophthalmologist's instructions with small hyphemas may be managed at home.
    Orbital blowout fractures: Ice and elevation of the head for 48 hours are recommended to reduce swelling. People are advised not to blow your nose as the pressure generated may pass through the fractured area and cause further problems.. Some ophthalmologists use nasal decongestants and oral antibiotics for one to two weeks. If any surgical repair is needed, it is usually done a few days to one week later when the swelling has gone down.
    Lacerations: Depending on the size and location of the laceration, suturing (stitches) may be necessary. If the cut is in a noncritical location, the laceration may be left to heal on its own. Lacerations to the eyeball often require antibiotics, sutures and more extensive surgery in an operating-room setting.