The ability to see can easily be taken for granted, and many people overlook proper eye protection when doing dangerous work. This is true even among workers whose occupations put them at risk for eye injury, such as welders, construction workers, and industrial cleaners. Each day about 2,000 US workers suffer job-related eye injuries that require medical treatment. Fortunately, most eye injuries do not lead to permanent vision loss, although they can be very painful and can significantly affect your ability to function. Here are some of the eye injuries most commonly seen in emergency rooms; follow the links to read more about them.
The Different Ways You Can Injure Your Eye
Corneal Abrasion (scratched cornea)
Corneal abrasion is one of the more common eye injuries. Most corneal abrasions affect the top layer of the cornea, the epithelium, which is loosely attached and easily scraped off. These kinds of eye injuries cause excruciating pain and intense sensitivity to light (also known as photophobia). This is because the cornea contains more nerves than any other part of the body, making it extremely sensitive. The injured eye appears red or bloodshot. Abrasions can be diagnosed fairly easily by applying yellow fluorescein eye drops to the eye. Abrasions will glow bright greenish-yellow under a blue light. Treatment consists of aggressive lubrication and close monitoring to make sure the scratch does not become infected. Your doctor may prescribe antibiotic eye drops as well, especially if you are a contact lens wearer or if your abrasion was caused by something dirty, such as a tree branch. In such cases it can be difficult to know whether the eye is completely clear of debris, and any debris left in the eye can lead to infection. Most abrasions heal within 24 hours.
When a corneal abrasion goes deeper into the stroma (the thickest middle layer of the cornea), then it is considered a laceration. The symptoms of a corneal laceration are similar to those of a corneal abrasion, but also include decreased visual acuity. If your doctor suspects a corneal laceration, you will need to be evaluated for a corneal perforation, which affects vision and may require surgery. Your doctor will perform a Seidel test to check corneal integrity. A fluorescein-saturated strip is wiped over the wound to see if dye flows down the corneal surface, which indicates leaking aqueous fluid. Surgical repair will be considered for a patient with a positive Seidel test. Patients will also be given antibiotics to prevent infection and systemic analgesia for pain relief. Severe lacerations can require several surgeries for repair and can result in permanent vision loss, or even blindness.
Eyelid lacerations—cuts through the eyelid tissues—often cause swelling and bleeding. They need to be managed carefully to prevent damage to the eye. For small lacerations, stitches may not be necessary, but larger lacerations will require suturing and treatment by an ophthalmologist. Your eye doctor will evaluate the lid to determine whether the laceration involves the lid margin and how close the cut is to the canalicular (tear drainage) system. A laceration near the tear drainage system, near the nose, may damage the drain, requiring silicone tubes to be inserted into the nose to keep the tear drain flowing. Most lid lacerations can be repaired without any complications, although special care must be taken to align the lid margins to avoid lid notching and misdirected eyelashes.
Just about anything can become lodged in the eye, from a grain of sand to a fishhook. If this happens, it is important to see your eye doctor right away or go to the emergency room. Flying metal is one of the more common causes of foreign-body eye injuries. Metal foreign-body eye injuries primarily occur to car repairmen, grinders, welders, and construction workers. Particles of metal stick to the cornea, causing small abrasions and discomfort. Metal rusts quickly and will form a rust ring within a day. If your eye is injured by a metal fragment, your eye doctor will need to remove both the metal and the rust. Before you can be treated for this type of eye injury, your doctor will first need to evaluate the possibility of an intraocular foreign body. Small metallic fragments in the back of the eye may not cause symptoms, but metal is very toxic to the retina and can kill the retinal cells if it is not detected. If your doctor suspects a penetrating eye injury, he or she may recommend a CT scan of the head to look for metal pieces. After removal of the foreign body, your eye will be patched and you will be scheduled for a follow-up visit. Most people with foreign-body injuries to the eye heal within a few days, with no lasting damage to their vision.
Chemical Eye Injury
Many chemical eye injuries are caused by household cleaners, which contain extremely dangerous and abrasive solvents like bleach and ammonia. Less common are chemical injuries caused by acids and bases, which can do even more damage to the eye. The first thing you need to do with any chemical injury is irrigate the eye. You should do this immediately, even before you call 911. Continue to irrigate the eye until help arrives. Pour at least several liters of room temperature water into each eye. Be sure to get underneath the eyelids and remove anything around the eyes, such as make-up, that may retain the chemical. On examination, your doctor will irrigate your eyes further before carefully examining them. A red, inflamed conjunctiva is actually a good finding; a white conjunctiva may mean extreme damage. Chemical injuries can lead to significant scarring that may require corneal transplant. The visual outcome depends largely on how quickly the chemical is washed out of the eye.
Blunt Eye Trauma
Blunt eye trauma, such as can be caused by a punch to the face or by an airbag deploying, can cause a variety of symptoms, depending on the degree of force. How the injury happened must be carefully described to help the doctor uncover any hidden damage to the eye and surrounding muscles and bones.
Orbital Wall Fracture
The bony orbital walls are thin and tend to break with blunt trauma to the eye. Fractures of the orbital floor and medial wall are the most common manifestation of this type of eye injury. Most of the time they cause swelling in and around the eye that resolves within a few weeks, and the orbital bones heal with no long-term problems. Examination after an orbital fracture will involve an evaluation of the patient’s vision and the optic nerve. The doctor will evaluate extra-ocular movements,proptosis (the degree of eyeball displacement outside the orbit), enophthalmos (the degree of eyeball displacement within the orbit), and nerve sensation on the forehead and cheek. Your doctor will also feel around the eye for any other fractures or air trapped in tissue (subcutaneous emphysema). If enophthalmos is significant and entraps fat or extra-ocular muscles, then surgical repair is necessary. Because most orbital fractures heal on their own without treatment, a follow-up visit a week after the injury is usually all that is required. Your doctor may recommend that you use a nasal spray and refrain from blowing your nose while the fracture heals. Some doctors may prescribe a short course of oral antibiotics to prevent an eye infection.
What Are The Complications of Eye Injuries?
One complication that can occur after blunt trauma injury to the eye is traumatic iritis, which is swelling and inflammation in the front half of the eye. The main symptom is painful sensitivity to light. Traumatic iritis causes what’s called “cell and flare” in the eye’s anterior (front) chamber— individual inflammatory cells floating within the aqueous fluid, and “flare,” which is diffuse protein that has escaped through inflamed blood-vessel walls. Your doctor can detect this by shining a narrow light beam into your eye at an angle. Treatment involves application of topical corticosteroids to decrease inflammation and cycloplegic eye drops to dilate the eye, which helps with photophobia. Traumatic iritis generally resolves within a week of treatment.
Hyphema—blood floating in the anterior chamber—is a common finding after blunt eye trauma. The amount of bleeding can vary. Most often the bleeding is microscopic — when the eye is examined the blood is seen as red cells floating in the aqueous fluid. The most common symptom is photophobia. Treatment of hyphema is similar to treatment of traumatic iritis; it includes corticosteroids and cycloplegic dilating eye drops. Your doctor may recommend that you sleep with your head elevated to help the blood settle. You will need to see your doctor daily until the eye heals because the bleeding may worsen, which could lead to clotting or high eye pressure, which can cause other eye problems. In most cases, the blood will clear without complication.