Eye Injuries Overview
Eye injuries can range from the very minor, such as getting soap in one's eye, to the catastrophic, resulting in permanent loss of vision or loss of the eye. These types of injuries often occur in the workplace, at home, from other accidents, or while participating in sports.
What Are Causes of Eye Injuries?
- 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 merely irritants to the eye and do not usually cause permanent damage. However, strong 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 alkaline substances (such as lye found in drain cleaner and ammonia) can splash into the eyes.
- Rubbing the eye when working with chemicals may transfer substances 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 a collection of blood lying on the surface of the white of the eye (sclera). The sclera is covered by the conjunctiva, which is the transparent blood vessel containing membrane that lies over the sclera. Subconjunctival hemorrhage may accompany any eye injury. It may also be spontaneous. 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 or that they wore their contact lens too long.
- 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 contains muscles that control 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 fist, getting kicked in the face, or being struck in the eye by a racquetball, squash ball, champagne cork, or some similar object.
- 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 fractures are breaks of the facial bones surrounding the eye. An orbital blowout fracture is a break in the thin bone that forms the floor of the orbit and supports the eye (orbital floor fracture).
- 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 potentially very serious and are frequently associated with trauma from sharp objects made of metal or glass.
- Foreign bodies in the eye: Generally, a foreign body is a small piece of metal, wood, or plastic.
- Corneal foreign bodies are embedded in the cornea and, by definition, 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 located 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, which is now lodged within the eye itself.
- 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 of the cornea. Common sources of damaging ultraviolet (UV) light are welding arcs, tanning booths, and sunlight reflected by snow, water, or other reflective surfaces, especially at higher altitudes where UV rays are more intense.
- 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 states where the person looks at the sun for an extended period of time.
What Are Signs and Symptoms of Eye Injuries?
- 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 is unassociated with other signs of trauma, it is not dangerous and generally goes away over a period of four to 10 days 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. Numbness of the upper lip on the affected side may occur. 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 an intense 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.
Types of Eye Injuries
Bleeding in the Eye (Subconjunctival Hemorrhage)
Most subconjunctival hemorrhages are spontaneous without an obvious cause for this bleeding from the conjunctival vessels. Often, a person may discover a subconjunctival hemorrhage on awakening and looking in the mirror. Most spontaneous subconjunctival hemorrhages are first noticed by another person seeing a red spot on your eye.
What Specialists Treat Eye Injuries?
Minor eye injuries can be cared for by your family doctor or by emergency-room doctors. For more serious eye injuries or if there are any questions regarding even the most trivial-appearing injury, an ophthalmologist should be consulted. An ophthalmologist is a medical doctor who has specialized in the diagnosis and treatment of eye disease. Some patients may need to consult a facial plastic and reconstructive surgeon.
When Should Someone Seek Medical Care for an Eye Injury?
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 emergency medicine physician at an emergency department or see an ophthalmologist (a medical doctor who specializes in eye care and eye surgery) if an ophthalmologist is readily available. A diagnosis and treatment plan should not be delayed due to searching for an on-call or available ophthalmologist. After initial treatment, discussion with and/or follow-up with an ophthalmologist is often advised.
In general, if a person is not sure if they have a serious eye injury, they should call an ophthalmologist or see an emergency-medicine doctor, preferably at a large hospital that has an ophthalmologist on call, for advice and/or treatment. In the event of eye injury to children, especially infants or toddlers, an examination should be performed emergently.
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, an 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, they should go to a hospital's emergency department, preferably one 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; some foreign bodies can be removed in an emergency department or urgent-care center but should be followed up by an ophthalmologist office visit.
- 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 About Eye Injuries
- Is there any sign of damage to the eye?
- Is there any sign of permanent vision loss?
How Do Health-Care Professionals Diagnose Eye Injuries?
As with any medical condition, the history is very important. How the injury occurred will often help the emergency medicine doctor or 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 an individual's eye(s) can achieve.
- To check for injuries to the cornea, the ophthalmologist or emergency medicine doctor usually places 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 shined into the eye, corneal abrasions turn green in appearance.
- 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.
Are There Home Remedies for Eye Injuries?
Self-care at home, in many instances, consists of emergent treatment before or during transport to a medical facility.
- Chemical exposures: The single most important thing to do for chemical exposures is to perform first aid by immediately washing out the eye with large 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; this may require the assistance of another person to help the patient keep their eye open during the wash out.
- 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, the individual should stand over the sink, cup his/her hands, and put his/her face into the running water.
- If a person is near a shower, he/she 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. Medical care should be sought 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 further 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 as this may cause 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.
First Aid and Treatment of Eye Injuries
- Chemical exposure: Even if the eye was irrigated at home, the ophthalmologist or emergency medicine doctor will probably have the eye irrigated again, possibly with a special device resembling a contact lens used for continuous eye irrigation termed a Morgan lens. 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 remove 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 to avoid secondary infection is a commonly utilized technique.
- Depending on the ophthalmologist, an eye patch 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 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 their 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. Consultation with an ophthalmologist is recommended.
Follow-up for Eye Injuries
- Chemical exposure: Follow-up depends on the severity of the injury.
- Subconjunctival hemorrhage: No follow-up is usually necessary if unaccompanied by any other injury to the eye.
- Corneal abrasion: Small abrasions in people who do not wear contact lenses need follow-up if their symptoms have not gone away in 24 hours or if they recur. Large abrasions and abrasions in people who do wear contact lenses will need to be closely monitored by an ophthalmologist to assess progress in healing.
- Traumatic iritis: Reevaluation in several days with an ophthalmologist is recommended.
- Hyphema: Such cases are best managed by an ophthalmologist. If the patient has not been hospitalized, follow-up is often performed the next day.
- Orbital blowout fractures: Outpatient follow-up occurs several days to a week after the injury.
- Lacerations: Follow-up depends on the nature and extent of the injury. In wounds thought to be at high risk for infection, a wound check may be done 24-48 hours after the injury. Skin suture removal is often performed five days after a lid laceration. However, if the eyelid margin has been repaired, those sutures may be left in longer (10-14 days). Eyeball lacerations will need to be closely monitored by an ophthalmologist.
- Foreign bodies: Corneal foreign bodies that were not embedded or cleanly removed by an ophthalmologist can have follow-up as needed. If a rust stain is present, follow-up with an ophthalmologist in one to two days is needed for removal. Deep foreign bodies of the orbit or globe of the eye require follow-up based on the severity of the injury.
- Light-induced injury: Ultraviolet keratitis in people who do not wear contact lenses needs follow-up if symptoms continue beyond 24 hours. People who do wear contact lenses should have follow-up until healing is complete. Contact lenses should not be worn until cleared to do so by the ophthalmologist. Solar retinopathy requires periodic follow-up with an ophthalmologist.
Is It Possible to Prevent Eye Injuries?
Most eye injuries can be prevented with safety glasses or other forms of eye protection such as full face shields often seen with motorcycle helmets or even welder's shields.
- People should wear safety glasses whenever they operate power tools, such as drills, saws, or power washers; when using a hammer; or when mixing or spraying chemicals.
- Welder's goggles or face masks should be used when using an arc welder. A common scenario for ultraviolet keratitis in welders is that the welder lights his or her torch with the welder's mask up and then flips it down after the torch is lit.
- Eye coverings should be used by people in tanning beds or in tanning booths, but it is best to completely avoid tanning, indoors and outdoors, to reduce chances of developing skin cancers or skin damage.
- Do not rub the eyes.
- Never look directly into the sun. When outdoors on bright, sunny days, wear good quality sunglasses. This will reduce the amount of ultraviolet exposure to the eyes. This is particularly important when there is significant reflective glare, such as at the beach, reading in the sun, on the water, or in snow-covered areas.
What Is the Prognosis for Eye Injuries?
- Chemical exposure: Prognosis depends on the chemical involved and the amount of exposure. Most chemical exposures to the eye are from substances that are not caustic (damaging) and the outlook for full recovery is excellent. However, strong acids and alkalis can be very damaging to the eye. Depending on the extent of the exposure, loss of vision can occur.
- Subconjunctival hemorrhage, corneal abrasions, and traumatic iritis: Generally, a full recovery is made.
- Hyphema: Prognosis depends on the size of the hyphema and whether or not bleeding begins again. Decreased vision and glaucoma are complications.
- Orbital blowout fractures: Prognosis depends on the nature and extent of the fracture. Some fractures require surgical repair. In general, the minor fractures heal without complications.
- Lid lacerations: Lacerations (whether requiring suturing or not) generally have very good outcomes. As with any cuts, infection is a potential complication along with scarring.
- Eyeball lacerations: These types of lacerations have a guarded prognosis.
- Foreign bodies of the cornea: Removal of a rust stain can result in scarring on the cornea. Depending on the location on the cornea, the potential for affecting vision exists, although it is not commonly a problem. Foreign bodies located inside the globe of the eye or in the orbit are more complicated. Prognosis depends on the exact location and how close the object is to critical structures in the eye.
- Light-induced injuries: Ultraviolet keratitis is similar to corneal abrasions regarding prognosis. Full recovery usually occurs within a few days. Solar retinopathy has no medical or surgical treatment. Prognosis depends on the amount of exposure from sun gazing. Permanent loss of vision can occur because of retinal damage.